BRES2015-0282LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 991174
Date ' Contra ct�oF-r' _,"Z_ �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the wdrk, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)238-0436
Llc. No.: 991174
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of thework for which this permit is issued.
L I have and will maintain workers' compensation insurance, as required by
Sectio�700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
Carrier:— Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
com ly with those provisions.
7
D e: 1
�t �' 2r ��APPIi6aa s�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
abovementioned property for inspection purposes.
Z�;.:P
D60 . / %.�T—) Signature (Applicant or Agent)
78-495 CALLE TAMPICO
U
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT.
(760) 777-7153
BUILDING PERMIT
i
'Date �]�/�2�5/2016
Application Number:
BRES2015-0282
Owner:
1
Property Address:
55930 PEBBLE BEACH DR
VIONELL B JACOBSON
APN:
775130020
16 WREN CRESCENT
Application Description:
JACOBSON RESIDENCE NEW
SFD 3,470 SF LA QUINTA, CA R7BOS
Property Zoning:
) "01
Application Valuation:
$366,630.10
--.-
'
�7
f:t ]r
O
CT:
Applicant:
Contractor:
771
" RICH LOPEZ INC
zi
P 0 BOX 2847
INDIO, CA 92202
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 991174
Date ' Contra ct�oF-r' _,"Z_ �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the wdrk, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)238-0436
Llc. No.: 991174
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of thework for which this permit is issued.
L I have and will maintain workers' compensation insurance, as required by
Sectio�700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
Carrier:— Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
com ly with those provisions.
7
D e: 1
�t �' 2r ��APPIi6aa s�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
abovementioned property for inspection purposes.
Z�;.:P
D60 . / %.�T—) Signature (Applicant or Agent)
- a DESCRIPTION ";
.'; ACCOUNT '"
`QTY AMOUNT.:'
PAID,
PAID DATE`
CHANGE OF CONTR/ARCH/OWNER
101-0000-42600
1 $97.17
$97.17
1/25/16
PROCESSING
..PAID BY
:'. METHOD _ '
�.
"J RECEIPT #
a--
F CHECK #
r CLTD BY.'.
VIONELL B JACOBSON
CASH
R12324
SKH
Total Paid for ADMINISTRATIVE: $97.17 $97.17
` ::DESCRIPTION g
- :ACCOUNT +
QTY
._ AMOUNT
{ PAID .
PAID DATE
ART IN PUBLIC PLACES - RESIDENTIAL
270-0000-43201
0
$416.57
$416.57
9/21/15
PAID BY
METHOD
RECEIPT # _
CHECK # -
f,CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for ART IN PUBLIC PLACES - AIPP: $416.57 $416.57
`DESCRIPTION
>; ACCOUNT ; .
QTY
AMOUNT
r a PAID ,, • .
PAID DATE:
BSAS SB1473 FEE
101-0000-20306
0
$15.00
$15.00
9/21/15
PAID BY
"� METHOD
'RECEIPT # 3
"
CHECK #
CLTD BY'
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $15.00 $15.00
DESCRIPTION i = , `
r ACCOUNT
QTY
�'AMOUNT �"
PAID
PAID DATEr
DIF - CIVIC CENTER
252-0000-43200
0
$942.00
$942.00
9/21/15
PA BY
t{ : 1 a: ` METHOD # %
RECEIPT #
CHECK4r,CLTD
By.
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION...'
A` !ACCOUNT
QTY
AMOUNT
?PAID
PAID DATE-
DIF - COMMUNITY CENTERS
254-0000-43200
0
$129.00
$129.00
9/21/15
PAID6BY
;•P; METHOD` .`
a `RECEIPT#
CHECK#, ._
€CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION -` x,
, }' ACCOUNT •.
QTY
AMOUNT^
'' PAID t, '` ' '
'PAID DATE:.
DIF - FIRE PROTECTION
257-0000-43200
0 .
$433.00
$433.00
9/21/15
' PAID BY `;`
-
* METHOD
RECEIPT # Nr,
CHECK # r
~`.CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION " £
i ' -; ACCOUNTS
CITY
y AMOUNT :
PAID
,PAID:DATE'
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
9/21/15
PAID
METHOD'
.RECEIPT # "
'CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION" . `' `.
s ACCOUNT
QTY
AMOUNT ti;
PARD =
PAID DATE
DIF - PARK MAINTENANCE
256-0000-43200
0
$40.00
$40.00
9/21/15
PAID.BY _ ,,
#;A x `: METHOD
RECEIPT #
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
"DESCRIPTION ` ,
ACCOUNT;: ' 1
QTY' ,
,: ,I.":AMOUNT
PAID �, ': '
PAID'DATE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$2,048.00
9/21/15
PAID BY
t + `METHOD €f ;
'_ RECEIPT #
'' CHECK #
€CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION "u_
` ACCOUNT
QTY
AMOUNT;
PAID Y
PAID DATE `
DIF - STREET MAINTENANCE
255-000043200
0
$116.00
$116.00
9/21/15
R :PAID BY y
METHOD-
RECEIPT #' .`
* ` CHECK # r
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION '',,
'ACCOUNTK
'QTY
AMOUNT.
'PAID
PAID DATE.
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
9/21/15
PAID BY
METHOD
` =RECEIPT ,# ' `
% " CHECK #; :
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for DIF -. SINGLE FAMILY DWELLING: $6,894.00 $6,894.00
DESCRIPTION ". ' d .
4ACCOUNT �,>, .
'QTY'
.ei . AMOUNTA
PAID .=
PAID DATE
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
9/21/15
*'PAID,BY n
F METHOD
RECEIPT #
CHECK # ? •
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION
ACCOUNT•`-
QTY..
, -AMOUNT:
PAID .•
=PAID DATE:
TEMP POWER SERVICE PC
101-0000-42403
0
$16.92.
$16.92
9/21/15
PAID BY ` ' :'
METHOD
' RECEIPT # y`;
CHECK #
CLTD BY
VIONELL BJACOBSON
CHECK
R9332
281
MFA
Total Paid for ELECTRICAL: $41.09 $41.09
DESCRIPTION
ACCOUNT
QTY
AMOUNT:.'
PAID•° :,
PAID DATE
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$49.32
$49.32
9/21/15
'PAID $Y
' METHOD
RECEIPT #.
' ` CHECK #
CLTO. BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION ..
ACCOUNT a
r QTY
., AMOUNT
PAID
PAID DATE.
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$20.32
$20.32
9/21/15
:PAID BY
:: 6METHOD
RECEIPT # M1x
'CHECK #
CLTD BY
VIONELL.8 JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION.
ACCOUNT
QTY
`4 .AMOUNT
PAID
PAID DATE.
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03
$145.03
9/21/15
PAID By�.r
METHOD
RECEIPT #
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION
ACCOUNT. "' -
QTY
AMOUNT
PAID
'PAID DATE`
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
$47.86
9/21/15
} PAID BY . ,1
METHOD '
�""'RECEIPT
CHECK # '
CLTD BY 3
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $262.53 $262.53
DESCRIPTICI.Nr
fACCOUNTCITY
AMOUNT
PAID
PAID DATE
RESIDENTIAL PRECISE GRADING - CUSTOM
HOME LOT >7KSF
101-0000-42408
0
$36.26
$36.26
9/21/15
PAID BY
METHOD
RECEIPT # :
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
r DESCRIPTION
ACCOUNT,
QTY
AMOUNT
PAID '_
PAID DATE
RESIDENTIAL PRECISE GRADING - CUSTOM
HOME LOT >7KSF PC
101-0000-42600
0
$181.29
$181.29
9/21/15
•PAID BY
°.`ACCOUNT e
• - METHOD
RECEIPT #
PAID
CHECK #
CLTD BY
VIONELL B JACOBSON
0
CHECK
R9332
9/21/15
281
MFA
Total Paid for GRADING: $217.55 $217.55
DESCRIPTION ,:
°.`ACCOUNT e
CITY''
+ .x AMOUNT
PAID
PAID::DATE
CONDENSER/COMPRESSOR
101-0000-42402
0
$108.78
$108.78
9/21/15
METHOD
RECEIPT,#CHECK
#
CLTD, BY: t!
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION $
4.. F
%Y ACCOUNT
5... o.t..
QTY
: AMOUNT'
#
PAID
PAIDDATE'''
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$72.51
$72.51
9/21/15
PAID`BY a
METHOD z
RECEIPT #
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION .A i z£
ACCOUNT _ ¢ r
QTY:..
_AMOUNT`
PAID
PATO DATE'
EXHAUST HOOD
101-0000-42402
0
$12.09
$12.09
9/21/15
` PAID BY
METHOD
u s RECEIPT #
CHECK #
CLTD BY .
VIONELL B JACOBSON
CHECK
R9332
281
MFA
+ DESCRIPTION
x = r
:,ACCOUNT w, ,
QTY.
AMOUNL
?AID
PAID'DATEi
EXHAUST HOOD PC
101-0000-42600
0
$4.83
$4.83
9/21/15
PAID.BY
i r" "' = METHOD
RECEIPT #
'CHECK # • -"
CLTD BY ,.
VIONELL B JACOBSON
CHECK
119332
281
MFA
DESCRIPTION+'
ACCOUNT;'
QTY.
p'`. AMOUNT:.'`
PAID
PAID DATE
FURNACE
101-0000-42402
0
$108.78,
$108.78
9/21/15
}' ;PAID BY
METHOD
. ': RECEIPT #
"CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
'DESCRIPTION ': r
;:'' ACCOUNT
QTY
AMOUNT .
PAIQ
PAID DATE
FURNACE PC
101-0000-42600
0
$72.51
$72.51.
9/21/15
PAID BY
METHOD , ar
RECEIPT #
CHECK #
CLTD;BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
r DESCRIPTION'`
�; ACCOUNT ,
QTY
AMOUNT
PAID
PAID.DATE
VENT FAN
101-0000-42402
0
$72.54
$72.54
9/21/15
`t PAID BY x. '"
METHOD
RECEIPT # _
CHECK # , `;
`CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION,"
ACCOUNT -:
QTY.
� AMOUNT
PAIDf "
',PAID -
VENT FAN PC
101-0000-42600
0
$28.98
$28.98
9/21/15
PAID BY • , , „-
METHOD "t e
` .+ F RECEIPT # £
' CHECK # -
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for MECHANICAL: $481.02 $481.02
DESCRIPTION "
ACCOUNT
MOUNT,'-,
PAID
PAIDL DATE
MULTI -SPECIES RESIDENTIAL 0-8 UNITS -
2015 UPDATE
101-0000-20310
0
$1,301.00
$1,301.00
9/21/15
, PAID BY .?•
METHOD . ,.:.
..;
RECEIPT #
K #,-4
GREG y
CLTD'BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
.Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00 '
.... n ,, ..
'r DESCRIPTION `:
.. .>.�:�
"_ > ACCOUNT x
AMOUNT
PAID
PAID'DATE'''
NEW CONSTRUCTION PERMIT
101-0000-42400
0
$638:33
$638.33
9/21/15
z '• `:; PAID BY
-QTY
;RECEIPT#
CHECK# i
CLTDYBY,'
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$70.40
$70.40
VIONELL B JACOBSON
CHECK
119332
281
MFA
jDESCRIPTION
ACCOUNT .�
;
AMOUNT
PAID F
'PAID
NEW CONSTRUCTION PERMIT
101-0000-42400
0
$32.84.
$32.84
7/27/15
�. PAIDBY '>
` METHOD r� '
'r RECEIPT#
`� CHECK#
° 'CLTD BY'
F
4
VIONELL B JACOBSON
CHECK
R7990
0068259777
MFA
Total Paid for NEW CONSTRUCTION PERMIT: $671.17 $671.17
:- :DESCRIRTION
ACCOUNT ," ra =
-QTY
66 .y AMOUNT :.
PAID
PAID DATE=
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$70.40
$70.40
9/21/15
44il),BY
METHOD{,
.RECEIPT #
CHECK #
~CLTD BY
VIONELL B JACOBSON
CHECK
R9332
.281
MFA
bESCRIPTION
;, ACCOUNT , r
`QTY'
" AMOUNTc ':
' PAID`' "
.PAID:DATE
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$1,367.16
$1,367.16
7/27/15
PAID, BY ~:
METHOD r k
<:RECEIRT # , "
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R7990
0068259777
MFA
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,437.56 $1,437.56
DESCRIPTION,
ACCOUNT • '
QTY,
AMOUNT''
PAID
PAID:DATE"
BACKFLOW DEVICE
101-0000-42401
0
$12.09
'$12.09
9/21/15
` PAID BY W
METHOD
RECEIPT #
CHECK # 2
xC1TD-BYE j
VIONELL B JACOBSON
CHECK
R9332
281
MFA
- ~`DESCRIPTION ;:
z :'ACCOUNT <_:
QTY:
.AMOUNT y
"PAID
PAID ,GATE
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
9/21/15
PAID BY
< PMETHOD.RECEIPT
# x
CHECK #
CLTD.BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION
ACCO.UNT�' .. ` F
QTY.'
AMOUNT'
» " t .PAID
PAID DATE
BUILDING SEWER
101-0000-42401
0
$12.09
$12.09
9/21/15
" PAID BY a
„tiMET z
HOD
p`� RECEIPT#. `
`:CHECK#
CLTD;BY '
VIONELL B JACOBSON
CHECK
119332
281
MFA
DESCRIPTION*`
** ACCOUNT xn
QTY,
AMOUNT '
=PAID
PAID DATE".
BUILDING SEWER PC
101-0000-42600
0
$12.09
$12.09
9/21/15
PAID BY . =1
- METHOD
r ' RECEIPT # n
CHECK #
CLTD BY,
VIONELL B JACOBSON
CHECK
R9332
281
MFA
7 ;rDESCRIPTION . '; „
' y %ACCOUNT
QTY
$
-AMOUNT
° ;PAID ,
PAID.DATE.
FIXTURE/TRAP
101-0000-42401
0
$205.53
$205.53
9/21/15
!: PAID BY .
y
METHOD
RECEIPT #
CHECK #CLTD
BY„,
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION `-
Y`
ACCOUNT r, 3°
=QTY .
.AMOUNT
PAID
PAID`DATE
FIXTURE/TRAP PC
101-0000-42600
0
$205.53
$205.53
9/21/15
PAID'BY”
r. METHOD '` -
3 'RECEIPT #
CHECK # '
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
TPAID PADA DESCRIPTION i
GAS SYSTEM, S+ OUTLETS
101-0000-42401:
0
$36.26
$36.26
9/21/15
PAID BY
' METHOD .,
j RECEIPT # ;
_ CHECK #
-CLTD 6Y-
VIONELL B JACOBSON
CHECK
R9332
281 -
MFA
DESCRIPTION % -
ACCOUNT"
QT.YAMOUNT
z PAID .
PAID DATE,
GAS SYSTEM, 5+ OUTLETS PC
101-0000-42600
0
$24..17
$24.17
9/21/15
e•, ., PAID BY,
"� METHOD ;�''
„ RECEIPT#
CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION
ACCOUNTT°=pa .,`
'QTY'
Y' AMOUNT'
PAID `
',PAID DATE
ROOF DRAIN
101-0000-42401
0
$132.99
$132.99
9/21/15
`PAID $Y p
s METHOD
RECEIPT# .,-`.;
� ° 'CHECK #
CLTD BY'
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION e'
ACCOUNT.
•QTY,
•, AMOUNT
PAID
PAID DATE
ROOF DRAIN PC
101-0000-42600
0
$132:99
$132.99
9/21/15
PAID BY `_ a
, •METHOD
r, < " •Y RECEIPT #
CHECK # :' '.
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
`<DESCRIPTION:'
ACCOUNT'
QTY
AMOUNT ''
Is_ 'PAID, '
PAID DATE,
WATER HEATER/VENT
101-0000-42401
0
$24.18
$24.18
9/21/15
PAID BY&. ,..
METHOD , ,
' `= RECEIPT #
CHECK #L'
CLTD BY.
VIONELL B JACOBSON
CHECK
R9332
281
MFA
DESCRIPTION `'`
'- -ACCOUNT t
QTY
«AMOUNT ,
PAID
PAID`DATE
WATER HEATER/VENT PC
101-0000-42600
0
$14.50
$14.50
.9/21/15
,PAIDBY �:,
:METHOD , ,`.�
RECEIPT
CHECK#
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
4, DESCRIPTION _
'ACCOUNT F
a �,,:,
QTY`,
AMOUNT ''
PAID
'PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.09
$12.09
9/21/15
"'PAID BY -
METHOD
RECEIPT #
CHECK # ':
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
'281
MFA
r> . DESCRIPTION
,. ACCOUNT-
fQTY
AMOUNT
PAID
PAID
D DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0,
$12.09
$12.09
9/21/15
PAID. BY
METHOD;::: .,
RECEIPT#
.CHECK #
,CLTD BY,
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for PLUMBING FEES: $841.43 $841.43
DESCRIPTION x
"ACCOUNT ."
QTY
"AMOUNT :`
PAID
PAID DATE,
SMI - RESIDENTIAL
101-0000-20308
0
$47.66
$47.66
9/21/15
PAID BY 4'
METHOD
-RECEIPT #
`CHECK #
CLTD BY
VIONELL B JACOBSON
CHECK
R9332
281
MFA
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $47.66 $47.66
DESCRIPTION'.'',
r, ACCOUNT,;,
.QTY'
.. AMOUNT
PAID
PAID DATE'
SINGLE FAMILY DETACHED
224-0000-20320
0
$1,837.44
$1,837.44
9/21/15
PAID:BY
METHOD
:RECEIPT # ;
'` `r CHECK #
CLTD BY
Description: JACOBSON RESIDENCE NEW SFD 3,470 SF
Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: ON HOLD
Applied: 7/27/2015 MFA
FAMILY DETACHED
Approved: 9/15/2015110
Parcel No: 775130020 Site Address: 55930 PEBBLE BEACH DR LA QUINTA,CA 92253
Subdivision: TR 20717-2 SEE ASSR MB 769 PGS 3134 Block: Lot: 28
Issued: 9/21/2015 MFA
3536
8/18/2015
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:.
Valuation: $366,630.10 Occupancy Type: Construction Type:
Expired: 7/19/2016 crw
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: NEW SFD @ 3470 SQ. FT. 884 SQ. FT. AIR CONDITIONED GARAGE, HOME IS FIRE SPRINKLED PER 2013 CRC CODES. THIS PERMIT DOES
NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, BBQ OR WATER FEATURES.
Applied to`A roved
• -,� Approved to. Issued ' g ,g
Printed: Monday, January 25, 2016 2:47:26 PM 1 of 10
SYSTEMS
ADDITIONAL ,
CHRONOLOGY
CHRONOIOGY,TYPE, _ STAFF NAME'.
=.ACTION DATE' i' COMPLETION DATE "` NOTES .
NOTE
JIM JOHNSON
8/14/2015
8/18/2015
NOTE
JIM JOHNSON
9/3/2015
9/15/2015
-NOTE
PLANS & DOCS PICKED UP FROM MARY'S DESK AND
KAY HENSEL
7/27/2015
7/27/2015 PROCESSED. STRUC TO YOUNG - DUE 8/17/2015
NOTE
MARY FASANO
7/30/2015
7/30/2015 DAVID HELLER PICKED UP PRECISE GRADING/GREEN SHEET
HELLER RENOVATIONS (CONTRACTOR) CAME IN TO REQUEST
• NOTE
MARY FASANO
1/25/2016
1/25/2016 HE BETAKEN OFF THIS PERMIT. I ATTACHED HIS REQUEST.
THIS PERMIT IS ON HOLD UNTIL OWNER COMES IN WITH
•
-
NEW CONTRACTOR.
Printed: Monday, January 25, 2016 2:47:26 PM 1 of 10
SYSTEMS
Printed: Monday, January 25, 2016 2:47:26 PM 2 of 10
sysrrms
PUBLIC WORKS GREEN SHEET, BURRTEC WASTE PLAN, AND
SUB -CONTRACTOR LIST MUST BE SUBMITTED AND
APPROVED PRIOR TO RE -OPENING OF PERMIT.
NOTE
MARY FASANO
1/25/2016
1/25/2016
ADDITIONALLY, TITLE 24 ENERGY REPORT MUST BE REVISED
AND RESUBMITTED AS PER DISCUSSION W/ PRIOR
CONTRACTOR BEFORE ANY FURTHER INSPECTIONS MAY BE
CONDUCTED.
PLAN CHECK COMMENTS
FROM CONSULTANT
JIM JOHNSON
9/15/2015
9/14/2015
RECEIVED
PLAN CHECK COMMENTS
,
FROM CONSULTANT
MARY FASANO
8/17/2015
8/18/2015
RECEIVED
PLAN CHECK PICKED UP
PHILIP JUAREZ
8/18/2015
8/18/2015
DAVID HELLER 760-285-9498 CAME IN AND PICKED UP PLANS
FOR CORRECTIONS.SCHOOL FEE LETTER GIVEN TO DAVID.
PLAN CHECK SENT TO
KAY HENSEL 5
7/27/2015
7/27/2015
STRUC TO YOUNG - DUE 8/10/2015
OUTSIDE PC
-
PLAN CHECK SUBMITTAL
MARY FASANO
8/17/2015
8/18/2015
'
RECEIVED
PLAN CHECK SUBMITTAL
PHILIP JUAREZ
y 7/27/2015
7/27/2015
PM 10 SUBMITTED PUT PLAN. REVIEW ROOM._
RECEIVED
GAVE TO AMY PUT IN HER CUBICLE.
RESUBMITTAL
MARY FASANO
8/28/2015
8/28/2015
TELEPHONE CALL
JIM JOHNSON
8/18/2015
8/18/2015
CALLED GABRIEL TO INFORM HIM PLANS ARE READY FOR
CORRECTIONS
CONDITIONS
`CONDITION DATE . DATE . DATE
, ,
CONTACT STATUS REMARKS =`'NO TES
'"
TYPE ;'• ;ADDED REQUIRED',. SATISFIED r' 4 �$
READY TO ISSUE 9/3/2015 PENDING
CHECKLIST
Printed: Monday, January 25, 2016 2:47:26 PM 2 of 10
sysrrms
Printed: Monday, January 25, 2016 2:47:26 PM 3 of 10
IVEY SYSTEMS
CONTACTS
•
NAME TYPE
NAME
ADDRESSIM
`CITY p=
STATE
ZIP'
PHONE
FAX,
EMAIL
CHECK t#'?'.
METHOD'��
PAID BY ='
LTD
. :..,
.
CONTRACTOR
RICH LOPEZ INC
P 0 BOX 2847
INDIO
CA
92202
(204)729-1070
CONTRACTOR
HELLER RENOVATIONS AND REPAIRS
67385 QUI10
CATHEDRAL
CA
92234
(204)729-1070
CONTR/ARCH%OWNER
(HISTORY)
1
$97.17
CITY
1/25/16
R12324
CASH
VIONELL B JACOBSON
OWNER
VIONELL B JACOBSON
16 WREN CRESCENT
LA QUINTA
CA
R7BOS6
(204)729-1070
Printed: Monday, January 25, 2016 2:47:26 PM 3 of 10
IVEY SYSTEMS
FINANCIAL••
•
ry DESCRIPTIONS si
' ' ,ACCOUNT
;•
QTY
�caAMOUNT
e.
a ,PAID
PAID`DATE
,�RECEIPT�#
CHECK t#'?'.
METHOD'��
PAID BY ='
LTD
BY
CHANGE OF
CONTR/ARCH%OWNER
101-0000-42600
1
$97.17
$97.17
1/25/16
R12324
CASH
VIONELL B JACOBSON
SKH
PROCESSING
Total Paid for ADMINISTRATIVE:. $97.17 $97.17
ART IN PUBLIC PLACES -
270-0000-43201
0
$416.57
$416.57
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
RESIDENTIAL
Total Paid for ART IN PUBLIC PLACES - AIPP: $416.57 $416.57
BSAS SB1473 FEE
101-0000-20306
.0
$15.00
$15.00
9/21/15•
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION
$15.00 $15.00'
BSA: 1
DIF - CIVIC CENTER
252-0000-43200
0
$942.00
$942.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - COMMUNITY
254-0000-43200
0
$129.00
$129.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
CENTERS
DIF - FIRE PROTECTION
257-0000-43200
0
$433.00
$433.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF -. LIBRARIES
253-0000-43200
0
$344.00
$344.00
9/21/15
R9332
281
CHECK -
VIONELL B JACOBSON
MFA
DIF - PARK
256-0000-43200
0
$40.00
$40.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
MAINTENANCE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$2,048.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - STREET
255-0000-43200 •
0
' $116.00.
$116.00
9/21/15'
R9332
281
CHECK
VIONELL B JACOBSON
MFA
MAINTENANCE
Printed: Monday, January 25, 2016 2:47:26 PM 3 of 10
IVEY SYSTEMS
t DESCRIPTION
ACCOUNT ..
CfTY '
.AMOUNT ,
PALO
PAID DATE
RECEIPT,#
CHECK #
,METHOD >
- PAID BY "
LT
EBy)
T ..-..
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
9/21/15
R9332
1 281
1 CHECK
VIONELL B JACOBSON
MFA
Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA•,
TEMP POWER SERVICE
101-0000-42403
0
$16.92
$16.92
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PC
Total Paid for ELECTRICAL: $41.09 $41.09
RESIDENTIAL, EA
101-0000-42403
0
$49.32
$49.32
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ADDITION 1,000SF
RESIDENTIAL, EA
101-0000-42600
0
$20.32
$20.32
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ADDITION 1,000SF, PC
RESIDENTIAL, FIRST
101-0000-42403
0•
$145.03
$145.03
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
1,0008E
RESIDENTIAL, FIRST
101-0000-42600
0
$47.86
$47.86
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA.
1,000SF, PC
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $262.53 $262.53
RESIDENTIAL PRECISE
GRADING - CUSTOM
101-0000-42408
0
$36.26
$36.26
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
HOME LOT>7KSF
RESIDENTIAL PRECISE
GRADING -CUSTOM
101-0000-42600
0
$181.29
$181.29
9/21/15
R9332'
281
CHECK'
VIONELL B JACOBSON
MFA
HOME LOT >7KSF PC
Total Paid for GRADING: $217.55 $217.55
CONDENSER/COMPRES
101-0000-42402
0
$108.78
$108.78
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
SO R
CONDENSER/COMPRES
101-0000-42600
0
$72.51
$72.51
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
. MFA
SOR PC
EXHAUST HOOD
101-0000-42402
0 1$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
EXHAUST HOOD PC
101-0000-42600
0
$4.83
$4.83
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Printed: Monday, January 25, 2016 2:47:26 PM 4 of 10
SYSTEMS
DESCRIPTION -
,ACCOUNT 7
' r... _
,.�.
QTY
x AMOUNT
PAID
PAID DATE E
---r--------
'.RECEIPT #
-*-rte-
CHECK #
$----
METHOD
PAID BY`. +.
CLTD
s •
:.. q
n
�
.*
FURNACE
101-0000-42402
0
$108.78
$108.78
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FURNACE PC
101-0000-42600
0
$72.51
$72.51
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
VENT FAN
101-0000-42402
0
.$72.54
$72.54
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
VENT FAN PC
101-0000-42600
0
$28.98
$28.98
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for MECHANICAL: $481.02 $481.02
MULTI -SPECIES
'
RESIDENTIAL 0-8 UNITS
101-0000-20310
0
$1,301.00
$1,301.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
- 2015 UPDATE
Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00
NEW CONSTRUCTION
101-0000-42400
0,
$638.33
$638.33
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA -
PERMIT
NEW CONSTRUCTION
101-0000-42400
0
$32.84
$32.84
7/27/15
R7990
006825977
CHECK
VIONELL B JACOBSON
MFA'
PERMIT
7
Total Paid for NEW CONSTRUCTION PERMIT: $671.17 $671.17
NEW CONSTRUCTION
101-0000-42600
0
$70.40
$70.40
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PLAN CHECK
NEW CONSTRUCTION
101-0000-42600
0
$1,367.16
$1,367.16
7/27/15
R7990
006825977
CHECK
VIONELL B JACOBSON
MFA
PLAN CHECK
•
7
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,437.56 $1,437.56
BACKFLOW DEVICE
101-0000-42401
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BUILDING SEWER
101-0000-42401
.0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BUILDING SEWER PC
101-0000-42600
0
$12.09
•$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FIXTURE/TRAP
101-0000-42401
0
$205.53
$205.53
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FIXTURE/TRAP PC
101-0000-42600
0
$205.53
$205.53
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
GAS SYSTEM, 5+
101-0000-42401
0
$36.26
$36.26
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA.
OUTLETS
Printed: Monday, January 25, 2016 2:47:26 PM 5 of 10
Wff SYSTEMS
DESCRIPTION •
ACCOUNT '` .
QTY -
-.AMOUNTY
PAID
PAID DATE
RECEIPT #',
t CHECK #',
',METHOD. '
PAID BY ``
CLTD:A
A ,
BY;
GAS SYSTEM, 5+
101-0000-42600
0
$24.17.
$24.17
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
OUTLETS PC
ROOF DRAIN
101-0000-42401
0
$132.99
$132.99
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ROOF DRAIN PC
101-0000-42600
0
$132.99
$132.99
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
WATER HEATER/VENT
101-0000-42401
0
$24.18
$24.18
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
WATER HEATER/VENT
101-0000-42600
0
$14.50
$14.50
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PC
WATER SYSTEM
101-0000-42401
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
INST/ALT/REP
WATER SYSTEM
101-0000-42600
0
$12.09
$12.09
9/21/15
R9332
281
CHECK .
VIONELL B JACOBSON
MFA
INST/ALT/REP PC
Total Paid for PLUMBING FEES: $841.43 $841.43 ;
SMI -RESIDENTIAL
101-0000-20308
0
$47.66
$47.66
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $47.66 $47.66
SINGLE FAMILY
224-0000-20320
0
$1,837.44
$1,837.44
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DETACHED
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
TOTALS: $14,561.19 $14,561.19
Printed: Monday, January 25, 2016 2:47:26 PM 6 of 10
SYSTEMS
Printed: Monday, January 25, 2016 2:47:26 PM 7 of 10
SYSTEMS
DWELLING FOOTING AND GARAGE STEM
FOOTINGS
JFU
11/2/2015
11/2/2015
PARTIALLY
-WALL. APPROVAL DOES NOT INCLUDE
APPROVED
GARAGE SLAB OR PATIO SLAB.
FOOTINGS
JFU
12/1/2015
12/1/2015
PARTIALLY
GARAGE SLAB ONLY..
APPROVED
OKAY TO WRAP
JFU
12/7/2015
12/7/1015
CANCELED
PRELIM. OK TO BUILD CRICKETS ONLY.
ROOF NAIL
JFU
12/7/2015
12/7/2015
PARTIALLY
RECALL WHEN ALL DRAINS, VENTS, ETC ARE
APPROVED
INSTALLED.
-ENGINEER'S OBSERVATION LETTER
REQUIRED -NO NFRC LABELS ON WINDOWS.
PROVIDE LIST OF WINDOW VALUES FOR
FRAMINGD
JFU
1/4/2016
1/4/2016
DISAPPROVE
EACH INDIVIDUAL WINDOW.-RODENT-
PROOFING AT EXTERIOR WALLS-FIREBLOCK
AT FIREPLACE -LOOP VENT MISSING -PROVIDE
DETAIL FOR FIX AT SERVICE PANEL SHEAR
WALL PENETRATION
NO NFRC LABELS ON WINDOWS.
APPROVED
OKAY TO WRAP
JFU
1/4/2016•
1/4/2016
W/EXCEPTIO
CONTRACTOR MUST PROVIDE LIST OF
WINDOW VALUES SPECIFIC TO EACH
N.
INDIVIDUAL WINDOW. -
ROUGH ELEC
JFU
1/4/2016
1/4/2016
DISAPDPROVE
SEE FRAMING INSPECTION NOTES.
ROUGH MECH
JFU
1/4/2016
1/4/2016
DISAPDPROVE
SEE FRAMING INSPECTION NOTES.
ROUGH PLBG
JFU
1/4/2016
1/4/2016
DISAPPROVE
SEE FRAMING INSPECTION NOTES.
APPROVED
need fix from eng for e
FRAMING
KKI.
1/14/2016
1/14/2016
W/EXCEPTIO
panel location
N
ROUGH ELEC
KKI
1/14/2016
1/14/2016
APPROVED
ROUGH MECH
KKI
1/14/2016
1/14/2016
APPROVED
Printed: Monday, January 25, 2016 2:47:26 PM 7 of 10
SYSTEMS
REVIEW TYPE,
SREVIEWER`
SENT DATE
DUE DATE�z
REVIEWS
STATUS,.
�
.REMARKS . ,
-
; NOTES
,DATE
� .
NON-STRUCTURAL-
JIM JOHNSON
7/27/2015
8/17/2015
8/14/2015
REVISIONS REQUIRED
3 WK
YOUNG
7/27/2015
8/10/2015
8/17/2015
REVISIONS REQUIRED
STRUCTURAL - 2 WK
ENGINEERING
PUBLIC WORKS
AMY YU
7/27/2015
8/3/2015
7/29/2015
REVISIONS REQUIRED
PLEASE ADDRESS ALL COMMENTS MADE ON THE -
PRECISE GRADING PLAN. "
2ND PW GREEN
BRYAN
8/4/2015
8/18/2015
8/17/2015
READY FOR APPROVAL
PER BRYAN MCKINNEY, COMMENTS HAVE BEEN
SHEET
MCKINNEY
ADDRESSED
FIRE
JACQUELINE
8/5/2015
8/19/2015
8/10/2015
APPROVED-
GARCIA
CONDITIONS
2ND BLDG NS (2
JIM JOHNSON
8/28/2015
9/11/2015
9/3/2015
APPROVED
WK)
2ND BLDG STR (2
YOUNG
8/28/2015
9/11/2015
9/14/2015
READY FOR APPROVAL
WK)
ENGINEERING
Printed: Monday, January 25, 2016 2:47:26 PM 8 of 10
SYSTGiv1S
Printed: Monday, January 25, 2016 2:47:26 PM 9 of 10
SYSTEMS
ATTACHMENTS
Attachment Type'
CREATED
- OWNER .
DESCRIPTION
PATHNAME_ -
SUBDIR
ETRAKIT ENABLED
BRES2015-0282 -
SPECIAL INSPECTION
DOC
1/25/2016
JAKEFUSON
REPORT - EPDXY
SPECIAL INSPECTION
1
REPORT-EPDXY
ANCHOR BOLT FIX
ANCHOR BOLT FIX.pdf
BRES2015-0282 -
ENGINEERS SHEAR
.
DOC
1/25/2016
JAKE FUSON
PANEL PENETRATION
ENGINEERS SHEAR
1
PANEL PENETRATION
FIX
FIX.pdf
BRES2015-0282 -
STRUCTURAL
STRUCTURAL
1/25/2016
JAKE FUSON
1
.DOC'
OBSERVATION REPORT
OBSERVATION
REPORT.pdf
'
BRES2015-0282 -
; s
INSTALLATION
INSTALLATION
=
DOC
1/25/2016
JAKE FUSON
CERTIFICATE. -
i • .
CERTIFICATE -
FENESTRATION
FENESTRATION.pdf
LAQ-I5-RS-127
LAQ-I5-RS-127
DOC
8/10/2015
JACQUELINE GARCIA
Jacobson
Jacobson
0
•Residence.docx
Residence.docx
DOC
8/14/2015
JIM JOHNSON
55-930 PEBBLE
55-930 PEBBLE
0
BEACH.docx
BEACH.docx
DOC
8/14/2015
JIM JOHNSON
SCHOOL FEES BRES2015-
SCHOOL FEES BRES2015-
0
0282.pdf
0282.pdf
1ST REVIEW.-
NEW CITY
-
DOC _
8/17/2015
KATHRYN SAMUELS
STRUCTURAL
TRANSMITTAL BRES
0
TRANSMITTAL
2015-0282 (ist).pdf
1ST REVIEW -
DOC
8/17/2015
KATHRYN SAMUELS.
STRUCTURAL
BRES 2015-0282 KS
0
(lst).doc
COMMENTS
2ND REVIEW -
NEW CITY.
DOC
9/14/2015
KATHRYN SAMUELS =
STRUCTURAL
TRANSMITTAL BRES
0 '
TRANSMITTAL
2015-0282 (2nd).pdf
Printed: Monday, January 25, 2016 2:47:26 PM 9 of 10
SYSTEMS
RECEDE®
JAN 2.5 2016
CITY OF LA C#U►NTA
COMMUNITY DEVELOPMENT
CITY OF LA QUINTA .- PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 9/25/2009
Green Sheet approvals are forwarded to the Building '& Safety Department directly by Public Works. Please DO
NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL
requirements listed below are complete. Incomplete applications or applications which cannot be processed wilt be
returned to applicant.
Date: /dcL/6 Developer: O O
Tract No. aQ7 Z 'tract Name:
Lot No.(s): aB
Address(s): 59-q 30 PPS k /4Z ZChone Number: jUY) 7Z% 107,6
The following are the requirements for Public Works Clearance to authorize issuance of .a building permit from the
Building & Safety Department:
❑ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4, #5 & #7 BELOW
❑ TRACT HOMES: PROVIDE ITEMS #1, #2, #3 & #5 BELOW
COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3, #5 & #7 BELOW
❑ WALLS, SIGNS, OTHER: PROVIDE ITEM #6 BELOW .
1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad
(maximum allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must be current (within 6
months of current date). If a precise grading plan creates the pad for approval, please withhold green sheet
submittal until'a Pad Elevation Certificate.can be provided.
2. Attach geotechnical certification of grading plan compliance including compaction reports from a licensed
Soils Engineer. Recently rough graded residential developments which 'have a previously approved
geotechnical certification are exempt from this requirement.
3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots.
4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, PM10
plan & agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy
plan. PM10 plans for commercial & residential developments (beyond 1 lot) are submitted. separately with
grading plans & are subject to additional requirements. A current PM10 certification number is required..
5: Attach a copy of the rough or precise grading plan to the Public Works Department showing building
location(s)-for pad elevation verification. AO flood zone developments will require an approved flood plain
development plan.
6. Attach supporting• documentation for wall plan, monument sign, grease trap or special facility installations.
7. Complete and sign the attached water quality management plan (WQMP) exemption form; if applicable. PW
approved building construction projects require either a WQMP or a completed WQMP exemption form.
Approved maps/plans may -be viewed at the following link: http://www.la-guinta.org/PlanCheck/rim search.aspx .
I have reviewed and confirmed the requirements listed above as presented and find the improvements to be
sufficiently complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s).
Pursuant to my findings, the above project may be released for building permit issuance. _;
This section completed by City staff �h�Y
p �
Recommended by: Date:
Public Works Distribution: () Green Sheet to Building & Safety
( ) Green -Sheet to Planning Department
Declined for approval for reason(s) as follow(s), please correct and resubmit:
T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 10-02-12.doc
City of La Quinta - PM10 Fugitive Dust Control Project Information
Construction Phase PM 10 Agreement (< 1 acre/lot or Infill Proiect)
Project Information
r
Project Contractor: R ` ��
t7
Project Phase
(check one)
❑ Construction
❑ Demolition
�4-L O A s�%� C)i&A (! —
Project Name: �- CS 'l
Project Tract/Lot Numbers: o)-01 -7 C,�_V
I f
Project Street Address: S 5 -! 3 oe lyJ {� !� !�5 �rc C !\
Total Acres in Active
Construction (< 1 acre per
Lot):
Anticipated Start Date: / / Anticipated Completion Date:
PM10 Contact Information
Please note: Dust control is required 24 hours a day, 7 days a week, regardless of
construction status. Person listed below is responsible for dust control during
business and non -business hours.
Name:`
C,/v I
Title:
T,( e- S
Company Name:
��M \ O �--
Mailing Address:
-73- b 1 L 1
City, State, ZIP Code:
(' i•^^ �� 4Qs.. CA 0% ZZ (e O
Primary Phone #:
to O - l
Fax #:
24 Hour Emergency
Phone#:
Cell Phone #:
51-4- 5 E-- I4
Email Address:
C In ✓t i .40'M J Z� •
PM 10 Certificate #:
C \/ 0 a — w 0 rZ -1.0
The above.stated property owner (or authorized representative):
Shall act as his/her .acknowledgement of dust control requirements and their enforceability, pursuant to
SCAQMD Rules 403, 403.1, 401, 402, 201, 203 and PERP;
.• Shall constitute an Agreement to comply with all project conditions as" identified in the approved dust
control plan.
Acknowledges that dust control is required twenty-four (24) hours a day, seven (7) days a week,
throughout the period of project performance, regardless of project size or status;
Shall ensure that each and every contractor, subcontractor and all other persons associated with the project
shall be in continuous compliance with all requirements of the approved dust control plan;
o Shall take all necessary precautions to minimize dust, even if additional measures beyond those listed in the
dust control plan are necessary; "
Shall authorize representatives of City/County to enter the property for inspection and/or abatement
purposes;
Shall Id harm[ ss the City/County and its representatives from Iiability for any. actions related to this dust
con I p nor n City/County initiated abatement activities.
c7vv
ignat e f Prop ty Owner or Authorized Representative Date
Applicant: Contractor:
HELLER RENOVATIONS AND REPAIRS HELLER RENOVATIONS AND REPAIRS
67385 QUIJO 67385 QUIJO
CATHEDRAL CITY, CA 92234 SL CATHEDRAL CITY, CA 92234
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 962615
Date: /2'�Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( ) 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY,
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)285-9498
Llc. No.: 962615
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
Compensation, as provided for by Section 3700 of the Labor Code, for the performance
cif the work for which this permit is issued.
_ I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 the r Code, I shall forthwith
comply with those provisions.
Date: -/ I /r Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose beneft work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to e t upon t e--
above-mentioned'property for inspection purposes.
Date: Z/ Signature (Applicant or Agent):
I
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA; CALIFORNIA
92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/21/2015
Application Number:
BRES20IS-0282
Owner:
Property Address:
55930 PEBBLE BEACH DR
VIONELL B JACOBSON
APN:
775130020
16 WREN CRESCENT
Application Description:
JACOBSON RESIDENCE NEW
SFD 3,470 SF
LA QUINTA, CA R7BOS-6
Property Zoning:
Application Valuation:
$366,630.10
Applicant: Contractor:
HELLER RENOVATIONS AND REPAIRS HELLER RENOVATIONS AND REPAIRS
67385 QUIJO 67385 QUIJO
CATHEDRAL CITY, CA 92234 SL CATHEDRAL CITY, CA 92234
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 962615
Date: /2'�Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( ) 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY,
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)285-9498
Llc. No.: 962615
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
Compensation, as provided for by Section 3700 of the Labor Code, for the performance
cif the work for which this permit is issued.
_ I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 the r Code, I shall forthwith
comply with those provisions.
Date: -/ I /r Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose beneft work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to e t upon t e--
above-mentioned'property for inspection purposes.
Date: Z/ Signature (Applicant or Agent):
J
411 r� -
ESCRIPTnO V - ACO N # Tlf Q2AIIIIOUN PAD
x� PAID DATE
�,. W4 Z
ART IN PUBLIC PLACES-, RESIDENTIAL 270-0000-43201.2
0; \F <, $,416 57 :'
$416:5F
cokk B� � ��� �.. :, MET
LA7
N, I I TAN
; `RECEIPT #
CH CKA#�. CLT;D BY
VIONELL BJACOBSON CHECKS
R9332
281 a,, MFA
;Total'Paid for,�ART IN PUBLIC PLACES' `'AIPP _' $416 5T z $416;57
WA 92, DESLRIPTIONJIM
YA C UNT
QTY AMOUNT
PAID'
M4 WF_
VP'-"=
BSAS SB1473 FEE
101-0000-20306;` . ,
0 ;. :$15 00 ,
$15:00 ,..
9/21/15
METHOD '
& +RECEIP#
z:�
r CHECK#
CLTD BY
VIONELL B JACOBSON
CHECK ' °^-
119332
,281
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA !; $15 00 ,.„ •$15:00
gp� SCRIPT ON
ACCO N
yr$r$TY�
AMOUNT
PAID
PAID AT, JE
DIF -CIVIC CENTER '
:'.252-0000-43200 .. -
0 ',
'- 1' $942.00 ,
$942,00
9/21/15:
7
P.AIU BY
�.. METHOD
SEI #0
CH CK # > ..
�>
CLTD BY
VIONELL B,JACOBSON '_
CHECK
It9332
, 281
MFA
E C IPTION�
����,_. .F�
�gCCOUNT �
14MOUNT
PAID
•.
PAID"DATES
A0%
DIF -COMMUNITY CENTERS
254-0000-43200
0 ''_,
::$129 00 .
$129.00
9/21/15•
Pi41D BY x y
ME�
y
CE#THOD RETS�
CHECK #1 . s
CLTD'BY
- 'VIONELL�B JACOBSON
; CHECK
; R9332
281
MFA -�
s < .DESCRL N. F 3 ��
"AWC NTA
' . §
T01 �
PAID
PAID
DIF - FIRE,PROTECTION
257-000043200'
0 " _ $433.00 °;
$433.00
9/21/15
�PAIU BY
. �
g.'
�METHOU _
RE E #
=
CHECK.#'
CLT:D BY
��
VIONELL B JACOBSON
CHECK .°.
R9332
281
MFA
4a
�AGCO�UN
°�
AMOUNT
PAID >
PAIID�DATE
DIF-, LIBRARIES
:i51 -0060A3200"_..,$3
.. 44 00
,. $344.00
9/'21/15 -
-
:.sv rPAIDBY
-_METHOD
RCMIllT#
'CHECK# ''
CLTOBY
VIONELL B JAC09SON
CHECK,
R9332
281
MFA
DESCRIPTION.' ` '
A
res,
Q� NT. xfinA
P�-.''
�I W
DIF - PARK MAINTENANCE
256-0000-43200 �
0 fi ';, $40.00
$40.00°, .: '
9/21/15'
•
``sxi�.+.' . -0 .a7
METHODS
i. .SYi#n `k
RECEIPT #
I fr '�'.
CHECK*#
ba C -
CLTD BY
liK X ,:
;VIONELL B JAC09SON ". `
CHECK
R9332
281
MFA- .
�DESCRIP,TION ,�,
x$a
ACCOUNT�N;
a .`. ,
AMOUNT
PAID
A�TE..
,DIF-PARKS/REC
<.251-0000-43200,
�0,.': '. $2,048.00
$2;048.00
9/21/15,
PAID BY :.
CECfff
CDY
IIAM
. ..
VIONELL B JACOBSON ,.
CHECK
'119332
281
MFA`
WR
ACCOUNT
QTY
AMOUNT
RAID
PAID'DATE
'
DIF -.STREET MAINTENANCE.. ��'�
.'255=0000 43200' ;,,
0 '
" - '.$116 00;'. ",
$11600 ' :
9/21/15
'
� PAIq
tx'-.a .1,
METHOD . a
REC PT #
r
CH CKK 9
:tea
CLTD BY
VIONELL B JACOBSON '
CHECK
119332 `
281
MFA
.1
s'.
{' °DESCRIPTION
.ACCOUNT s.
Y, 111
A OWN„I
�ql”
-
50-RATION 2000-43200
`
2,842 00 "
$2,84
9/21/15DIFTRANSPO
M i
• � ? j r `� L ?� .�,Ly ��ki RI 2.i f
' • `r �" .t �a 1 , •A �i. t ,� r i ft..VQ��y✓s�1 q 3 ?y st
c i. •i
AID BY a
MCHOD
RCET
CHECK'#
CLTDFBY
VIONELL'B JACOBSON
CHECK
9 R9332
MFA
Total Paid for DIF' -:SINGLE FAMILY DWELLING _`$6,894.d6',.: $6,894 00
DESCRIPTION ,
ACCOUNT �:
��
���'
EDWIN
AMOUNT ". K
FAID
PAID DATE
TEMP POWER SERVICE
101-0000-42403..
1 0 '
$24 17
$24.17
9/21/15
PD 'IM�ETHOD
ur.
ER CEIP#v
w,f
C CKY#
CLTD BY
:r
VIONELL B JACOBSON
CHECK
R9332
281
MFA.
_&&,., DESCR!" T N
ACCOUNT
r 4 �
AIVIOIJ �
' -�
PAL ��
$16;92
PLAID DATE
TEMP POWER SERVICE PC �'i-
101-0000-4240316.92
' PAI!*"B
�z e
�METHOO�
.�.a �a ztsax ' a.
RECEIPT #
CHECKS#
CLTD-BY
VIONELL B JACOBSON
CHECK','R933,2
Total Paid for.ELECTRICAL $41 09 , ' $41.09
DESCRIPTION�.�
cx ittt�,a,:�^etz..z:e,
ACCOUNT - ,,
x.< SIR
QTY
AMOUNT
,vsr.e. s..
PAID -'sR...w
�pAT
RESIDENTIAL, EA ADDITION 1,0005E `• ,
101-0000-42403
0 ,'
'_ -$49 32 , '
$49.32.
:9/21/15 ',
PAID BY. �'
VIONELL B JACOBSON
ETHOD'°. °�
CHECKJ.
RE EIPT# .
R9332
CH C#
281
CLTDnBY
MFA
DEE!RIPTION 1
ACCOUNT
QTY
AMOUNT
PAID
PAI DA? TES
RESIDENTIAL, EA ADDITION 1,000SF, PC ;.
'101-0000-42600
0_-'$20.32
:
$20.32
;-`9 /21/15
PAIDq B� �
n`� "•3:5��^ '*"Kr.�k,tX`
M HODS
F9Ja:`s'At�" ;3 ifTw.
ER C IE PTS#
_ .� ., �D ".a6 i<X<Y�� {.$i �. 9
CH K,,# 0
tf �1,.
CLTD BN
. !HIsn}Y�ir
VIONELL;B JACOBSON
CHECK - -
R9332
281 4
MFA
DESCRIPTION
MTNii A OUNT
PA�
PAID DATE
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
$145.03 . -
$145.03
9J21/15
PAID; BY
„ VIONELL B JACOBSON
METHOD
CHECK
RECEIPT#
R9332 .
CIiK #
281
CLTDrBY
MFA',
C' D# RI ON
RESIDENTIAL, FIRST 1,000SF, PC
ACO NT
101-0000-42600
Q
TY
0 ..'
AMOUNT
, `$47.86: `.
PAID ,
$47.86 • :;
PAIDxDATE
:9/21 15,
R-` ..PA:BYj
MI10D����up
.. R ECffffi14, F,
CHECK#
C BY...
VIONELL-B JACOBSON
CHECK(
`R9332
"281 �.
r `. 'MFA :'� ;
Total Paid.for;ELECTRICAL-`NEW CONSTRUCTION:,:$262 53 y' $262:53
.,s
ECR CT ONS
�>:Ynm
ACCOUNT
QTY
AMOUNT
'• $36 26
a ,Yf
PAID
$36:26
PAID DATE
t
.9/21%15,
RESIDENTIAL PRECISE GRADING - CUSTOM .
HOME LOT.>7KSF..
101 0000-42408
0
�'PIDYa �
�MHOD
R C
R9332
CHC K #
281
CLTD BY
IVIFAJ
VIONELLBJACOBSON.
CHECK
IDES K PTION;•
ACCO T ,
QTY
A OUNT
PAID
PARD ANTE•
RESIDENTIAL PRECISE'GRADING -CUSTOM `
HOME LOT >7KSF PC
. 101 0000 42600`
0 .
' $18129 .; ;
$181.29
9/21/15.
' `PAID BY
METHOD
M:E a
RE EI i
R9332
CHE #
281
PC LTD, BY
MFA
VIONELL B JACOBSON
CHECK
—Total Paid.for GRADING �� $2.17 55 ��� � $217-.55
,. •DESCRIPTIONS
5az , i%W'nn7YfffYu:vv k�t�l,{Cr} .'.moi '`v"Nih:°
ACCOUNT ^�
Xfi,7?3.it:k"..fe.
QTY
'.�s
AMOUNT
P'AID ",PAID,
�,P.x°X
DAA
' `CONDENSER/COMPRESSOR �
. ;101-0000-42402 `
$,108 78,K
9/,31/15
7.
�. PAiIBY METHOD RECEIPT # `1 'GHEC.wK CLTDBY
VIONELL B'JACOBSON
`CHECK
��
33
xs
QTLY 1►MOUNT.
281.'
PAID eN
"MFA
PAIUDATE
.,ACOUNT
DESCRIPTION Q jz
CONDENSER/COMPRESSOR PC
lO1 0000;42600" ,: "
' 0' ; .$72 51 ;
$72:51 f•`
• -9/21/15
�3 ' PtAIDBYd�¢
ME��RECE
P 4#'
C#`
.50
�C T ABY
'
VIONELL;BJACOBSON
CHECK
R9332
'281
MFA
? DES�CR�JO�N
ACCO
QTY '
Ar OUNT,
PAI x
PAIO.DATE
EXHAUST HOOD -
101-0000.-42402
0
$12 09
$12:09
9/21%15
:x
VIONELL 'BJACOBSON
��
ET O� .
CHECK
>LECEIPT # '"
119332 "
u
HyECK #�
281
CLT, BY
MFA
HOOD PC
ACCOUNT
101-0000-42600
QTY
0 '
AMOUNTS
. $4 83
Pr
PAID
j[
$4:83
PAID�DATE
9/21%15 "
v PAID .
,,.,. MET, 16D � �
RE EST � . ,,
CCNU BY
� .
VIONELL B JACOBSON
CHECK - <, .
119332
281
MFA
.JM�
i §DESCRIPTIONs
�
FURNACE
CO 1NT ��,
,. � �
101;0000-42402 `
QTY
0
�p ,
AM 9
:$108 78
.n P
$108.78
��
P
9/21/15'
PAI BY
VIONELL B JACOBSON
ME ,HO0 `'
m.�sv 4
,CHECK " `
REEt�PT=;CHEK#
R9332
281
CLsT'
MFA
DESC IPTION
_ , , r �
ACCOU T `
vA;9 PO
QTY
AMOUNT
PAID
.
PAID ATE
FURNACE PG
101-0000,-42600
0 ;'.
' $72:51: '
$72':51
9%21/15
?I9
F
Lmv �D
:RPT.#.,
CK
CL"B
VIONELL'B JACOBSON :: . ,
'CHECK
119332 ,
281
MFA ;,
;DESCTIIN
IMIN NQTY
'
� OU T.
P ID� '
PAID DAT
• "VENT FAN '_
101-000042402 < ,
0 .,
•: $72 54 ',
$72:54
9/21/15;
-
�PAI
VIONELL B JACOBSON
METHOD
CHECK
RECEIPT #=
119332
CHECK #
281
CDY
::' :MFA
DR P ION
�ACCOII
Jx s4„+�Ri
QTY'.
x�RC
AMOUNT
,rt'F§+lati9
PAID��
f{rsr4k,''
PAIU-D TjT
#_
..
VENT FAN PC-
..
101-0000-42600 `
:: 0 ,,
$28 98
'$28.989/21/15-
METHOD �
d ��-�.
RECEIPT #
CHECK # .,
ti ,
CLTOBY
-;
VIONELL'BJACOBSON ' '
CHECK
'119332281
MFA
Total Paid fo`r' MECHANICAL: ; $48102 $481.02
°�
u DESCRIP�TI .. ...
•
MULTI SPECIES RESIDENTIAL 0-8 UNITS 7101-0000-20310"
2015 UPDATE
c
_ � � T'
QTY
0 • .
M�� T �.
$1,30100
�D v'. ,
$1,30100
,fP�AIbDQDATE
9/21/15
aPAtD BYE:
PA.
METHODS
CHECK,119332
ECE IPTG#
��k
CHECK #
281
CLT:D,BY ;
CL,T
MFA. .°
1
VIONELL B JACOBSON
Total-Paid for MULTI-SPECIES.RESID ENTIAL: $1'301.0 0 �= ,$1,301 00 -
��ACCOUNT�
f�• DESCRIPTION.
QTY
AMOUNTS'
PAID ,PAIDDATE'
NEW CONSTRUCTION PERMIT.,
101-0000-42400'.
0 ,
$638.339/21/15
PAID.esY
METHOD
�' :.•
:RECEI#
CFIECK#
CLbTD BY
VIONELL B.JACOBSON ` ,
CHECK
119332 t i
a� 281 .' ,
4 .° 'MFA'
CRRIPT�N,'�
`C NT
TAUN
D O E
PA
_s ' F •`' ` ,1g12t
z
?
pA1Df6Y?HOD
1
CHE
CL�TD BY . ,
VIONELL B JACOBSON
CHECK '
117990
t i
0068259777
'MFA
Total Paid for NEW CONSTRUCTION PER
., $671.17
� DESCR PTION
A COUNT
. r.,.� � a' a
QTY
.s
NEWCONSTRUCTIONPERMIT..
✓ .' 'k :; :i,..xt "`k`
EMS=
101W-aC0000-42400-,•
0 ,`•
$32.84•-7/27/15
0,
= , $70'.40'-
" $70.40
9/21/15
` PAID. BY3 ,.
, . . >.` s
-. RRECEIPT�
119332
C HE #
; 281
,.
VIONELL B JACOBSON
CHECK
NEW CONSTRUCTION PLAN CHECK
101-0000;42600.
r�4,�� �`S"�F(
AMOUNT
$1,367.16
A D x
$1;367.16 ; _
��Y
,�, AYE' P
." �METHOD�" � �+'
a x , �.n•.x
*Mei:SY''.,�5
k.�RECEIPT#
sw� '_ �d
CHECK#,CLTDBY
�. cam.
pA1Df6Y?HOD
..FRET#',
CHE
CL�TD BY . ,
VIONELL B JACOBSON
CHECK '
117990
t i
0068259777
'MFA
Total Paid for NEW CONSTRUCTION PER
., $671.17
� DESCR PTION
A COUNT
. r.,.� � a' a
QTY
.s
AMO T
✓ .' 'k :; :i,..xt "`k`
EMS=
pAI A E
A ip
NEW CONSTRUCTION'PLAN'CHECK' ..
101-0000-42600 _
0,
= , $70'.40'-
" $70.40
9/21/15
` PAID. BY3 ,.
, . . >.` s
-. RRECEIPT�
119332
C HE #
; 281
C T� Y
MFA,
VIONELL B JACOBSON
CHECK
NEW CONSTRUCTION PLAN CHECK
101-0000;42600.
Y/ACCOUNT QTY
0
AMOUNT
$1,367.16
A D x
$1;367.16 ; _
PAID DATE
sem.
7/27/15
NQ MPAID�BY ���.:
a •
." �METHOD�" � �+'
a x , �.n•.x
k.�RECEIPT#
sw� '_ �d
CHECK#,CLTDBY
�. cam.
:
VIONELLBJACOBSON
CHECK �'
117990
0068259777
MFA ,'
TotaLPaid for NEW CONSTRUCTION PLAWCHECK ' • $1,437.56: $1,437.56
DE SC N' If
ACCO NT
QTzY
AMOUNT
PAID
PAIDDATE
BACKFLOW DEVICE
101-0000-42401,• r
0 •.
- $12`.09' `,
:.s
$12.09
9/21/15
�-
:ME=
.` PAID BY �. .cam
-
a ,_, b g M H�
,,. <R- -h � �
R9332
CH K ..
X281
�. ..
Bl(
IN :m
' �.; M -
VIONELL B JACOBSON,
s `
CHECK
ED 5 P k, ?�
I r. Y�% Cs� �� �., .x
TAY
Q� , s
%�M9 ANT'
P D�DATE
BACKFLOW DEVICE PC
101-0000-42600.
0 `" .
$4.83
$4.83 - . -
'.9/21/15
=- PAID BY
x�a, : �.H
:: aMETH�OD :: ,
z REC P $#"
. r, n Q�
CHECK#
CLTDBY
VIONELL B JACOBSON
CHECK :.'
R9332
,281
IM' M
DE CR PTION �
�..a .o."
ACCOU T
�,Y
101-0000-42401-,
QTY
0
AMOUNT ..
,
= $12.09
PAID
$12:09
�
_PARI DTE
.9/21/15 ,
BUILDING SEWER
u P DBY
EEIPT#�
CHECK #CL
D B
VIONELL B JACOBSON
CHECK 'y
• . < 119332
281
-MFA '
,, �DESCRIRTION Ns
,ACO T
E(2T�Y
AMOUNT
;PAID
I-P�A D DATE
BUILDING SEWER PC ,.
101-0000 42600`
0
$12.09 ',,•.
$52:09 : '
9/21/15
mPA D BY v
VIONELL�B JACOBSON�
METHOD°
�.
CHECK
''.
RECE T tt s�
°yid'.
• '119332
&A CK #
- . 281,.MFA
CLT BY
1%64 SiX
DESCRIPTION4•
S5. 1._I
-/'xk2•?'SkSkv"x'A'i5�.'�GS..SS 'bf �•i.'£9v.r.:c _...
ACCOUNT
3E 'c"'.`.'.SY4,S'2?
101-0000-42401
0
AMOUNT
'2x"!Yid:Gs Vii.
$205.53
PAID
'E
111 MA
; PAID ATE1
",cLiii Jiu'
FIXTURE/TRAP
$205.53',';
9/21/15
'PAI BYt���
_ ,':�'..Sr`t'#MSJTM&`k`15.`'s3''iida`s't.:"3
SME HOD
vu•93(i i'N.:CS': r.53
RECE PT#
'-tf•.i
CHECK
'£G_`Cfi:S4N+axd
Y4::'SkY ..L
VIONELL'B JACOBSON
CHECK ..
R9332
-281
MFA
DESCRIPTION' � �
FIXTURE/TRAP PC
ACCOUNT
101-0000-42600:
N ' A(VIOIJNT
$205.53
„ PAID��?r
$205:53
PAIDI, ATE
=.9/21/15'
_ ME HOD
RECEIPT #
a . Tj
CIiECK #
_ w
C T B
VIONELL B JACOBSON
CHECK
119332. '.
281
MFA
IDESCRI�PTIQvN�s
s . _..:. ACCOUNT
QTY
6 "AMOUNT
PASPAIDDATE
GAS SYSTEM, S+OUTLETS'
101-0000-42401 -
0
' ;$36.26 ``•
;; $36.,26 j,.
� 9/21/15 ;
E11D�BY � ,
xMETHOD} 2
A�RECEIPT #x � r
CHEOK #' g
�CLTU B
VIONELL B JACOBSON
CHECK
�' 119332
MFA
,. i4�� ars s
5 RIPT�ION
S ACC UNTOQTY
,
AMOUNT -0
PAID YFAIUDATE
+
GAS SYSTEM, S+ OUTLETS PC, 101-0000-42600% 0 $24.17 t - $24;17
`PAIDBY' r
MEOO�
CE EIPT # ��
CHECK #
CL�TDBY
.,�R
3.
VIONELL AJACOBSON •
2 CHECK
119332 ' '
281 + r °
MFA
D SGRIf FTION
AC OIJ . .
QTY
A O NT
IN PAD
PAID DATE ;
41 ROOF DRAIN .=,
1.01-0000-42401
. x, ,. �PA D -N r
= M aH � •
RECE T
c E #
-LT,D"BY s
VIONELL B JACOBSON.
CHECK
119332
281
V
MFA
< 1
'U: CR�F�TN
W ACCOUNT
QTY
AMOUNT
PAID.
PAIDDATE
ROOF DRAIN PC
301-000042600
0
:$13,2,., ..99
$132.99
gg
WN'10 BY
w PAID,BY ���
METHOD
RECEIPTS#"' r s
EIPMT #
Wig
CHECKS#
CH EC,
CL'�Ta g
la"�,I, '2� M
�'..` a'L ,. ,.
i.4x'N4k ..�k�
VIONELL BJACOBSON
CHECK
= 119332
281 _ -
.MFA'
� D SCRI, PTION
C T'
Q A OUNT:Q
A�
A §A
y`
WATER HEATER/VENT
101-0000-42401:
0 ; $2418'`;
$24.18
9/21/15'`
PA BY
INS, '�.. 9r'�'#. .., .�'
, ...
� METHOD M
' ,4 .Y.:�''�
;� RECEIP #';'
Xe.2 '+ . _
CHECK #
, u5 .. ''.,�',§sE6dRs,'ti
CLTD BY
z'
. ,.
. ".
VIONELL B JACOBSON 'f
CHECK '• ,
R9332� , •
281.
;',.MFA `
IN
DESCRIP,TION;,
ACCOUNTS,
Q�.
AMOUNT:
PAID
PAID<DA E
�.
_-
WATER HEATER/VENT PC'-," '
101-000042600$14.50
9/21/15,
PS BYE ���
Pffijr
METHOD
TT 0 Y
CST'#
CK
CLTD BY
wax , ..
,R
y
BCH s
4r
• :
VIONELL.B JACOBSON • .
CHECK
, "119332 ,
281
MFA
-w ' I` DESCRIPTION
�ACCOWNT
�
A�MOUN7
P D�
t'PAI DAT
Djp
.,
. ... , s�'t a ....
a ,x:�,.rr4 ` m
,', mac:
'sr,.5yc.1 �
.
WATER SYSTEM INST/ALT/REP
_101-0000-42401
0
.$12 09
$12.09
RECP#
ffiff
CHEM#' m.
CLTD'BY
VIONELL B JACOBSON
CHECK ..
R9332.
281
MFA
.
SC T��
;�A000UsN ..
�QY
:...: MOUNT
PAID
AiNDATE
'...
WATER SYSTEM INST/ALT/REP PC.
101-0000-42600. •
0 ,'
$12.09
$12:09 ' ':; °
'9/21/15 ,
.
`..h PA D BY .`(
K T
RE
Rlfb
..
.,
:,..C�HE
.VIONELL B JACOBSON
HECK
n,_,R9332
'S' X281
MFA
Total�Paid for -PLUMBING FEES ,,' ', $841.43 $841:43:
..
ESC
WIND
.
MN
X�
�
.
SMI "- RESIDENTIAL
101-0000-20308• y
0 ` z _' . $47.66'.. `
.., n
$47:66 , "
9/21%15
..
r'..AID BY4nMETHOD
4REC.E TP #.
CHE ...., ,
` CLTp:BY
'
VIONELL B JACOBSON
CHECK
k:
119332..
281
MFA
".
Total Paid for STRONG MOTION INSTRUMENTATION SMI ' -• $47.66 $47.66 '.
'D SCRIPTION� ��
ACCOUNT
�h
�QfY .<�.
AMO NTS
PAID . ,
PAIDDATE
`
SINGLE FAMILY DETACHED
_ .224-0000-20320'
0 r
$1,837.44;
$1,817.44 •
9/21/15,
K
PAID-BY3 ,
„� . Vii;
METHOD£
�,>�..'
RECEIPT#
�
CHECK #
CL`�TD1BY
VIONELL B JACOBSON'
CHECK
119332
.281
MFA'
Total Paid for TOME -,RESIDENTIAL:. $1,837 44 $1,837.44,
. _
L '
'• ' it � .
fid. a � psi Sv » 5 q r i i
t � a ✓�
, a ! , Bio- a �
,s }
Description: JACOBSON RESIDENCE NEW SFD 3,470 SF
Type: BUILDING, RESIDENTIAL Subtype: DWELLING -SINGLE Status: ISSUED
Applied: 7/27/2015 MFA
FAMILY DETACHED
Approved: 9/15/2015 JJO
Parcel No: 775130020 Site Address: 55930 PEBBLE BEACH DR LA QUINTA,CA 92253
Subdivision: TR 20717-2 SEE ASSR MB 769 PGS 3134 Block: Lot: 28
Issued: 9/21/2015 MFA
3S36
..,-.:.. b �:...
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $366,630.10 Occupancy Type: Construction Type:
Expired: 3/19/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
8/18/2015
Details: NEW SFD @ 3470 SQ. FT. 884 SQ. FT. AIR CONDITIONED GARAGE, HOME IS FIRE SPRINKLED PER 2013 CRC CODES. THIS PERMIT DOES
NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, BBQ OR WATER FEATURES.
50 v 6
Applied to Approved ;" 7 _
o- Approved to Issued'
Printed: Monday, September 21, 2015 9:31:24 AM 1 of 7
SYSTEMS
ADDITIONAL
CHRONOLOGY
-aCHRONOLOGY TYPE,
w-.
NAME
..� ;<r ,4,NOTES
ACTION COMPLETION DATES
..,-.:.. b �:...
..STAFF
_. . „ .
NOTE
JIM JOHNSON
8/14/2015
8/18/2015
NOTE
JIM JOHNSON
9/3/2015
9/15/2015
NOTE
KAY HENSEL
7/27/2015
7/27/2015
PLANS & DOCS PICKED UP FROM MARY'S DESK AND
PROCESSED. STRUC TO YOUNG - DUE 8/17/2015
NOTE
MARY FASANO
7/30/2015
7/30/2015
DAVID HELLER PICKED UP PRECISE GRADING/GREEN SHEET
PLAN CHECK COMMENTS
FROM CONSULTANT
JIM JOHNSON
9/15/2015
9/14/2015
RECEIVED
PLAN CHECK COMMENTS
- FROM CONSULTANT -
MARY FASANO
8/17/2015
8/18/2015
RECEIVED
-
t
DAVID HELLER 760-285-9498 CAME IN AND PICKED UP PLANS
PLAN CHECK PICKED UP
PHILIP JUAREZ
8/18/2015
8/18/2015
FOR CORRECTIONS.SCHOOL FEE LETTER GIVEN TO DAVID.
Printed: Monday, September 21, 2015 9:31:24 AM 1 of 7
SYSTEMS
u
~s
C6' :OF'19iE9
PLAN CHECK SENT TO
KAY HENSEL
7/27/2015
7/27/2015
STRUC TO YOUNG - DUE 8/10/2015
OUTSIDE PC
PLAN CHECK SUBMITTAL
MARY FASANO
8/17/2015
8/18/2015
-
RECEIVED
PLAN CHECK SUBMITTAL
PHILIP JUAREZ
7/27/2015
7/27/2015
PM 10 SUBMITTED PUT PLAN REVIEW ROOM.
RECEIVED
GAVE TO AMY PUT IN HER CUBICLE.
RESUBMITTAL
MARY FASANO
-8/28/2015
8/28/2015
CALLED GABRIEL TO INFORM HIM PLANS ARE -READY FOR
TELEPHONE CALL
JIM JOHNSON
8/18/2015,
8/18/2015
CORRECTIONS
CONDITIONS
DI
,COCONDITION
i "&,. '..t '�' '• "3 ..F
DATED. , "DATE *=fDATE',: `; k.%x• < r.Ay r rt`.. , A y p ,•
. .._ ihn. ' f,_:
j "' 'D i .Yy '.:. G':d:....: z,s vl. �. STATUS REMARKS
' ~TYPE' w
2CONTACT
:...:>.. ,r.¢.. .3
ADDED ? MREQUIRED.SATISFIEp
.w ,'. :.?.;
s .w
,€�^,. �,w,
,° .. .I,
- �'
kNOTESs��
READY TO ISSUE
9/3/2015
PENDING
CHECKLIST
--
CONTACTS
IVANIE TYPE
- SNS a :,
" .NAINIE... ,
ADDRESSl CITY`F
STATE
ZIP
€ PHONES
'FAX' ys
EMAIL
..
.
t a_
APPLICANT
HELLER RENOVATIONS AND REPAIRS
67385 QUIJO
CATHEDRAL
CA
92234
(204)729-1070
CITY
CONTRACTOR
HELLER RENOVATIONS AND REPAIRS
67385 QUIJO
CATHEDRAL
CA
92234
(204)729-1070
CITY
OWNER
VIONELL B JACOBSON
16 WREN CRESCENT
LA QUINTA
CA
R7BOS6
(204)729-1070
Printed: Monday, September 21, 2015 9:31:24 AM 2 of 7
SYSTFnAS
DESCRIPTION
ACCOUNT -
QTY
r. AMOUNT
PAID
PAID DATE
RECEIPT.#CHECK#;
•METHOD
PAID BY
C LTD"
a
BSAS SB1473 FEE
101-0000-20306
0
$15.00
$15.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION $15.00 $15.00
BSA:
DIF - CIVIC CENTER
252-0000=43200
0 -
$942.00
$942.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - COMMUNITY
254-0000-43200
0
$129.00
$129.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
CENTERS
DIF - FIRE PROTECTION
257-0000-43200
0
$433.00.
$433.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - PARK
256-0000-43200
0
$40.00
$40.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
MAINTENANCE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$2,048.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DIF - STREET
255-0000-43200
0
$116.00
$116.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
MAINTENANCE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
TEMP POWER SERVICE
101-0000-42403
0
$16.92
$16.92
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PC
Total Paid for ELECTRICAL: $41.09. $41.09
RESIDENTIAL, EA
101-000042403
0
$49.32
$49.32
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ADDITION 1,0005E
RESIDENTIAL, EA
101-0000-42600
0
$20.32
$20.32
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ADDITION 1,000SF, PC
RESIDENTIAL, FIRST
101-0000-42403
0
$145.03,
$145.03
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
1,0005E
Printed: Monday, September 21, 2015 9:31:24 AM 3 of 7
sysrr•Ms
a
Printed: Monday, September 21, 2015 9:31:24 AM 3 of 7
sysrr•Ms
' Permit Details. PERMIT NUMBER
City of La Quinta
BRES201502:82
a.
Printed: Monday, September 21, 2015 9:31:24 AM 4 of 7
SYSTEMS
A
`�
� x
CLTD
DESCRIPTION
: p. ACCOUNT "
QTY
'AMOUNT
PAID
,PAID DATE
•±RECEIPT #
CHECK #
' ME,THOE�
PAID BY
Y
RESIDENTIAL, FIRST
101-0000-42600
0
$47.86
$47.86
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
1,000SF, PC
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $262.53 $262.53
RESIDENTIAL PRECISE
GRADING - CUSTOM
101-0000-42408
0
$36.26
$36:26
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
HOME LOT >7KSF
RESIDENTIAL PRECISE
GRADING - CUSTOM
101-0000-42600
0
$181.29
$181.29
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
HOME LOT >7KSF PC
Total Paid for GRADING: $217.55 $217.55
CONDENSER/COMPRES
101-0000-42402
0
$108.78
$108.78
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
SOR
CONDENSER/COMPRES
101-0000-42600
0
$72.51
$72.51
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
SOR PC
EXHAUST HOOD
101-0000-42402
0 _
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
EXHAUST HOOD PC
101-0000-42600
0
$4.83
$4.83
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FURNACE
101-0000-42402
0
$108.78
$108.78
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FURNACE PC
101-0000-42600
0
$72.51
$72.51
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
VENT FAN
101-0000-42402
0
$72.54
$72.54
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
VENT FAN PC
101-0000-42600
0
$28.98
$28.98
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for MECHANICAL: $481.02 $481.02
MULTI -SPECIES
---
RESIDENTIAL 0-8 UNITS
101-0000-20310
0
$1,301.00
$1,301.00
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
- 2015 UPDATE
Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00
NEW CONSTRUCTION
101-0000-42400
0
$638.33
$638.33
9/21/15
R9332281
11
CHECK
VIONELL B JACOBSON
MFA.
PERMIT
.
Printed: Monday, September 21, 2015 9:31:24 AM 4 of 7
SYSTEMS
DESCRIPTION
- ACCOUNT • .
QTY
AMOUNT
PAID
PAID DATE.
RECEIPT #
'CHECK
METHOD
PAID BY
CLTD
;
NEW CONSTRUCTION
101-0000-42400
0
$32.84
$32.84
7/27/15
R7990
006825977
CHECK
VIONELL B JACOBSON
MFA
PERMIT
�
7
Total Paid for NEW CONSTRUCTION PERMIT: $671.17 $671.17
NEW CONSTRUCTION
101-0000-42600
0
$70.40
$70.40
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PLAN CHECK
NEW CONSTRUCTION
101-0000-42600
0
$1,367.16
$1,367.16
7/27/15
R7990
006825977
CHECK
VIONELL B JACOBSON
MFA
PLAN CHECK
7
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,437.56 $1,437.56
BACKFLOW DEVICE
101-0000-42401
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BUILDING SEWER
101-0000-42401
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
BUILDING SEWER PC
101-0000-42600
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FIXTURE/TRAP
101-0000-42401
0
$205.53
$205.53
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
FIXTURE/TRAP PC
101-0000-42600
0
$205.53
$205.53
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
GAS SYSTEM, 5+
101-0000-42401
0
$36.26
$36.26
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
OUTLETS
GAS SYSTEM, S+
101-0000-42600
0
$24.17
$24.17
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
OUTLETS PC
ROOF DRAIN
101-0000-42401
0
$132.99
$132.99
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
ROOF DRAIN PC
101-0000-42600
0
$132.99
$132.99
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
WATER HEATER/VENT
101-0000-42401
0
$24.18
$24.18
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
WATER HEATER/VENT
101-0000-42600
0
$14.50
$14.50
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
PC
WATER SYSTEM
.101-0000-42401
0
$12.09
$12.09
9/21/15 1
R9332
281
CHECK
VIONELL B JACOBSON
MFA
INST/ALT/REP
Printed: Monday, September 21, 2015 9:31:24 AM 5 of 7
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE .
RECEIPT,#
CHECK :#
'METHOD
PAID BY
CLTD
BY.,:.
WATER SYSTEM
101-0000-42600
0
$12.09
$12.09
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
INST/ALT/REP PC
NON-STRUCTURAL -
JIM JOHNSON
7/27/2015
8/17/2015
8/14/2015
REVISIONS REQUIRED
Total Paid for PLUMBING FEES: $841.43 $841.43
SMI - RESIDENTIAL
101-0000-20308
0
$47.66
$47.66
1 9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $47.66 $47.66
SINGLE FAMILY
224-0000-203200
$1,837.44
$1,837.44
9/21/15
R9332
281
CHECK
VIONELL B JACOBSON
MFA
DETACHED
AMY YU
7/27/2015
8/3/2015
7/29/2015
REVISIONS REQUIRED
PLEASE ADDRESS ALL COMMENTS MADE ON THE
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
$14,464.02 $14,464.02
Printed: Monday, September 21, 2015 9:31:24 AM 6 of 7 c
SYS7Eti1S
PARENT.O
RETURNED
PREVIEW TYPE" .
REVIEWER
SENT DATE
DUE,DATE, -
STATUS :
'-DATE
REMARKS
NOTES <"
..• �� . <
NON-STRUCTURAL -
JIM JOHNSON
7/27/2015
8/17/2015
8/14/2015
REVISIONS REQUIRED
3 WK
STRUCTURAL - 2 WK
YOUNG
7/27/2015
8/10/2015
8/17/2015
REVISIONS REQUIRED
ENGINEERING
PUBLIC WORKS
AMY YU
7/27/2015
8/3/2015
7/29/2015
REVISIONS REQUIRED
PLEASE ADDRESS ALL COMMENTS MADE ON THE
PRECISE GRADING PLAN.
2ND PW GREEN
BRYAN
8/4/2015
8/18/2015
8/17/2015
READY FOR APPROVAL
PER BRYAN MCKINNEY, COMMENTS HAVE BEEN
SHEET
MCKINNEY
ADDRESSED
FIRE
JACQUELINE
8/5/2015
8/19/2015
8/10/2015
APPROVED-
GARCIA
CONDITIONS
Printed: Monday, September 21, 2015 9:31:24 AM 6 of 7 c
SYS7Eti1S
I
2ND BLDG NS (2
WK)
JIM JOHNSON
8/28/2015
9/11/2015
9/3/2015
APPROVED
TED D
2ND BLDG STR (2
YOUNG
8/28/2015
9/11/2015
9/14/2015
READY FOR APPROVAL
WK)
ENGINEERING
LAQ-I5-RS-127
LAQ-15-RS-127
DOC
Printed: Monday, September 21, 2015 9:31:24 AM 7 of 7 -
syszr:Ms
BOND INFORMATION
ATTACHMENTS
':DESCRIPTION PATHNAM ' ; ��- ,. K .- r
SUBDIR - E.TRAKIT� ENABLED �.
TED D
:`.`OWNER
a .:.: �... -
Attachment Type
,e
;CREAti _
. , „,.
LAQ-I5-RS-127
LAQ-15-RS-127
DOC
8/10/2015
JACQUELINE GARCIA
Jacobson
Jacobson
0
Residence.docx
Residence.docx
55-930 PEBBLE
55-930 PEBBLE
DOC
8/14/2015
JIM JOHNSON
BEACH.docx
BEACH.docx
0
SCHOOL FEES BRES2015-
SCHOOL FEES BRES2015-
DOC
8/14/2015
JIM JOHNSON
0282.pdf
0282.pdf
0
1ST REVIEW -
NEW CITY
DOC
- 8/17/2015
KATHRYN SAMUELS
STRUCTURAL
TRANSMITTAL BRES
0
TRANSMITTAL.
2015-0282 (1st).pdf
1ST REVIEW -
BRES 2015-0282 KS
DOC
8/17/2015
KATHRYN SAMUELS
STRUCTURAL
(lst).doc
0
_
_
COMMENTS
2ND REVIEW -
NEW CITY
DOC
9/14/2015
KATHRYN SAMUELS
STRUCTURAL
TRANSMITTAL BRES
0
I I
I
TRANSMITTAL
2015-0282 (2nd).pdf
GRANT DEED 55930
Grant Deed 55930
DOC
9/17/2015
STEPHANIE KHATAMI
PEBBLE BEACH Jacobson
Jacobson.pdf
0
Printed: Monday, September 21, 2015 9:31:24 AM 7 of 7 -
syszr:Ms
Building
Address
Own r
P.O. BOX 1504
`— 8-495 CALLE TAMPICO
lx�AAUINTA, CALIFORNIA 92253
Mailing
Address
A co
II ff��
w're-n
L
(./� �VZSce.. 1
pity
Edon
lZip1
Tel.
Contrac r
O1i
7 r
Address
CiZi
Tel.
State Lic.
& Classif.
C`
`
City
Lic. #''",� G
Arch., Engr.,
Designer V 1
Y -N
Address
Tel
co,)
Zip
State
Q y 0,0 a' t Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is in full force and effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
(Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct,
alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac-
tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
01, as owner of the property, or my employees with wages as their sole compensation, will do
the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon and who does such work himself or through his own employees, provided that
such improvements are not intended or offered for sale. If, however, the building or improvement
is sold within one year of completion, the owner -builder will have the burden of proving that he did.
not build or improve for the purpose of sale).
O I, as owner of the property, am exclusively contracting with licensed contractors to construct the
project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
I certify that in the performance of the work for which this permit is issued, I shall not employ
any person in any manner so as to become subject to Workers' Compensation Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
APPLICATION ONLY
BUILDING: TYPE CONST L L OCC. GRP.�-
A.P. Number ���7 ' 1 CL>t4)
Legal Description 6 �� �� k l �.�k
Project Description
III r I to
Sq. Ft. 2 ® No.
Size-/ Stories
New f�J' Add ❑ Alter ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
TOTAL
CONTACT INFORMATION
NAME:
PHONE:
No. Dw.
Units
Demolition ❑
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line —
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line —
FINAL DATE —
Issued by:
Validated by: —
Validation:
YELLOW = APPLICANT
INSPECTOR
Date Permit
PINK = FINANCE
A.
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 3 90:9,—� 98-1224
AUG 2 8 2015
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVELONEAMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMWIND. AMOUNT:
DATE:
RECEIPT:
CHECK #:INITIALS
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: PGA W s Date: August 28, 2015
Owner's Name: Vinell Jacobson Phone No. 760-285-9498
Project Address: 55-930 Pebble Beach Dr., LaQuinta, CA
Project Description: New SFD/AC Garage
APN: 775-130-020 Tract #: Lot #'s:
Type of Development: Residential XX! Commercial
Total Square Feet of Building Area: 4,354
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: August 28, 2015 Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code
65995
4354
$628.00
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87. Requirement
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees. Sunrise (KSL)
Agreement 1986.
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Certificate issued by: Laurie Howard, Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a'written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally; the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof.. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted.
M V:c/mydocs/devfees/cel1i ficate of compliance for n updated 3-2007 11/2010
Lay ym, Title
DOC # 2015-0228645:'
RECORDING REQUESTED BY: / r . 06/01/2015 02:22 PM Fee .00
/Lawyers Title 'aAC4 C#p j` 0 : Page 1 of 3
AND WHEN RECORDED MAIL TO:
Recorded in Official RecordsF
� v County of Riverside •- + ` '" ` ` � �`• ••
Pebble Beach Property Trust :' - Peter Aldana y.
16 wren crescent
2 �' , Assessor-County Clerk-Recorder-
Brandon, Manitoba, Canada, I R7B OS6 4
"This document was electronically submitted
Order No.: 615693003 to the County of Riverside for recording–
Escrow No.: FS973 Receipted by: SOPGOME2
A•P.N.: 775-130-020-3 TRA 020-025
r 0.i G .
I" 0zo - ° 4s, SPACE GRANT DEED VE THIS LINE IS FOR RECORDER'S USE'
,
THE UNDERSIGNED GRANTOR(S) DECLARES) j
DOCUMENTARY TRANSFER TAX IS $ 302. SO
[ X ] computed on full value of property conveyed, or ,
[ ] computed on full value less value of liens or encumbrances remaining at time of sale.
[ ) unincorporated area" • [ X ] City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, • +�
Equity Trust Company Custodian FBO James Cox IRA #106365
hereby GRANT(S) to Frances Ann Jacobson and Jacaline Sophia Guthrie, Trustees
of the Pebble Beach Property Trust dated May.1, 2015 a
the following described real property in the County of Riverside, State of California
See Exhibit "A" attached hereto and made a part hereof.
Commonly known as: 55930 Pebble Beach. La Quinta, CA 92253"
Dated: April, 2015 �.. .
A notary public or other officer completing this certificate `
verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the ,Equity Trust Company Custodian FBO James
truthfulness, accuracy, or validity of that document. Cox I # 06365
STATE OF 1D L%�
} SS. By: Authorized Signer Victoria St—
UN COUNTY OF Q�
On ` before me, t
0 a notary public,
personally Lt,,
�Y r)dr c i�llr'r nCJ �i q A.�
who proved to me on the basis of satisfactory evidence to be the
personpQ whose name(09are subscribed to the within `
instrument and acknowledged to me that he/&/they executed y
the same in higd2 /their authorized capacity(fe), and that by
his/her/their signaturegj on the instrument the personOq, or the -
entity upon behalf of which the person(A0 acted, executed the
instrument. '
I certify under PENALTY OF PERJURY under the laws of the `
State of California that the foregoing paragraph is true and
correct. 'v ale,,
MONICA KETCHAM
WITNESS my hand and official seal. Notary Public, State of Ohio z
MY Commission Expires
Signature�`'---i/�--".—_:_",• .4rF pF 0�-,•.December25,2019 � . ,
l)
(Sea'
(This area for official notary seal) •' ` ;,
MAIL TAX STATEMENTS AS DIRECTED ABOVE , .
S�
U
�� ��<�
v I '
l9�'�
lie
. 16
CITY OF LA QUINTA PUBLIC WORKS DEPARTMENT GREEN� SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
updated d &,effective .912512009
•\
G-6 I en Sheet approvals are forwarded to"the
. Buil I . in I c Public. Works. Please DO NOT
i & Safety directly by Pub
submit the Green Sheet (Public Works Clearance) Packet ,to the.,PublicWorks Department until ALL requirements listed
below are -complete. Incomplete applications or ap6lications which cannot be processed will be reiturne6to applicant.
'Date: 07/ 0 i-OPbeiveloper:
Tract is16.., 2, 0 17--2Tract Name: lot'No.(s):
Phone, Number:.( Di -71
,Addreo(s)' 5!� 43 0' 0-k !Q 1070
The following are the requirementi for Public Works Cleararice'to authoriz6 issuance of a building permit from the
Building & Safety Department:
A.- CUSTOM HOMES-- PROVIDE -ITEMS. #2, #3, #4, #5  BELOW
4- TRACT M BELOW
44. COMMERCIAL BUILIJINGSIOTHER: PROVIDE'ITEMS41, #2, #3, OS & 0 BELOW
WALLS, SIGNS: .OTHER: PROVIDE ITEM #6 BELOW
1. Attach^P6d, Elevatioii-,Certificatei in compliance with the approved design-elevationc for building pad (maximum
allowable deviationof�tl-0.1foot)
Pad-
bevati6n -Certificates' must be current (within 6 months of current date).
l
If a precise grading plan creates 'the,,pad ,for,approvcll, please withhold green. sheet submittal until a,Pad Eleva ion
Certificate can be` provided.
2. Attach Jeotib''I"- if
' hhica cirt cat
' ion of grading; plan '-Compliance including compaction reports from a licensed Soils
Engineer.,- Re6en"tlyrough graded residential developments which have a previously approved geotechnical
certification are -exempt from this,requitement.
3; Attach recorded final map or title information/grant deed,showing proposed building locations are ilegal lots.
4. Complete the attached <1 acre, per lot or infill project Fugitive. Dust Control project information form, PM10 plan &
agreement or; provide alternative & valid City approved PM10 plan set reference number or hard copy .plan. plans for commercial.& residential developments (beyond 1 lot) are submitted separately with grading -plans
are subject tcadditiobal, requirements. A current PM10 certification number is required.
5. Attach �a copy'of the rough, or -precise grading,plan to the Public Works Department- showing buildinglocabon(s)
for pad elevation verification. AO flood zone developments will require awipproved flood plain development plan.
6' Attachsupporting documentation, for wall plan;. monument sign, grease, trap or special facility installations.
7. Complete - and sign the attached, water quality management plan (WQMP) exemption form,,, if applicable., PW
approved building construction projects require either a WQMP,.of a completed NVOMP exempti on form..
Approved maps/plans may be viewed at the following link: ta,org/PlanCfieck/m, search .aw?(
I have reviewed and confirmed the requirements listed above as presented and find the improvements,to be sqfficiently
complete for construction of the proposed buildihgs/structurdstwalls/signs on the subject lot(s). Pursuant to -my findings,.
the above project may be released for building permit issuance.
This section,6ompleted, b,y, City staff.
ley)—
A
Recommended by; Date:
Vreen Sheet to -Building '& Safety. A
Public Works Distribution: 6,�r
Gr'eenShe.et:toPlanning ,Depirtment C,0^ S k- -e- laae,
Declined for approval for reason(s) as follow(s), please correct and:resUDMII:
TA ists �'Foffns i Ap0cawnsxForms a AwicaitionsWEEN SHEET caqw,9 PM10 less th1n fAae Re��.� 9�2&09.dor,'
• REOmtv.
J 1IJ L F.7
%U
INTA
COMMUNI-11"i DEVELOPMENT
"��L;� ..ie � „•. •. �
Him
`�'
City of La Quinta - PM10 Fugitive Dust, Control Project Information `
Construction Phase PM10 A reement. <1 `acre/lot or Infill Project)
PM10 Certificate #:
C- V 5 - 3 8 b
Pro ect Information
Pro ect Contractor: Q (2 i U Ct 0 1\9 -
Project Phase
Project Name:_ F} C D C O IIS; i S V ttJe-• N c E
(check one)
v,
Project Tract/Lot NumL�ers: a017 1 h UT a
•
Construction`
Demolition
J
Project Street Address: 5 cr , q 36' -PF-6Ph 8LACH rt
-
q Q- -3' .
�----r `
Total Acres in Active
Construction (<1 acre per:,
Start Date:08 / 15 /�NAnticipated CompletionDate: 41 /-5'/
Lot);
PM10 Contact
Please note: Dust control. is required 24 hours a day; 7 days a week, regardless of
status.- Person listed below is responsible for dust control,during business and
Information
construction
non -business hours.
• Name:
_ v ` Title:
CO IQ T ►2 ! " c--7 O VC
,
Company Name.
C j,.� G --f2 �,'QOA � i`�-1 [ o IVs 4- GPM R
Mailing Address:
g u v
C C) r A 1K, C- (
Ci State, ZIP Code:
'Primary Phone #•
760 a
•
z
N
Fax #:
24 Hour Emergency
f c1 f
p -1 �� 8
%lo v �S
Phone#:
.. /
The above stated property owner (or authorized representative):
•: Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD
Rules 403, 403.1,,401--402, 201,`203 and PERP;
fi Shall constitute an Agreement to comply with all project conditions as -identified in the approved dust control plan.
❖ Acknowledges that dust control is required twenty-four (24) hours a day, seven (7),days.a week, throughout the
period of project performance, regardless of project size or status;,
Shall ensure -that each and every co
contractor, subcontractor and other persons associated with the project shall
be in continuous compliance with all requirements of the approved dust control plan;
❖ Shall take.all necessary precautions to -minimize dust, even .if additional measures beyond'those listed in the dust
control plan are necessary;
❖ Shall authorize representatives of Ciry/County to enter the property for inspection and/or abatement purposes;,
Shall hold harmless the runty and its: representatives from liability for any actions related to this dust control
plan or any.0 /Co initiat a ' e nt`activitie_s
Signature of Property or.Authorized Representative Wild
M :
TAChoddistc- Forms B Appfic2tia41Fonns B ApplicetionclGREEN SHEET covor 9 PMW bas than l Acre:Revised 9-2549.dor '`. - • . :
Cen.rnone s-
Email Address:
r .,v o- v 1 �.
\2, v' �v a�
PM10 Certificate #:
C- V 5 - 3 8 b
The above stated property owner (or authorized representative):
•: Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD
Rules 403, 403.1,,401--402, 201,`203 and PERP;
fi Shall constitute an Agreement to comply with all project conditions as -identified in the approved dust control plan.
❖ Acknowledges that dust control is required twenty-four (24) hours a day, seven (7),days.a week, throughout the
period of project performance, regardless of project size or status;,
Shall ensure -that each and every co
contractor, subcontractor and other persons associated with the project shall
be in continuous compliance with all requirements of the approved dust control plan;
❖ Shall take.all necessary precautions to -minimize dust, even .if additional measures beyond'those listed in the dust
control plan are necessary;
❖ Shall authorize representatives of Ciry/County to enter the property for inspection and/or abatement purposes;,
Shall hold harmless the runty and its: representatives from liability for any actions related to this dust control
plan or any.0 /Co initiat a ' e nt`activitie_s
Signature of Property or.Authorized Representative Wild
M :
TAChoddistc- Forms B Appfic2tia41Fonns B ApplicetionclGREEN SHEET covor 9 PMW bas than l Acre:Revised 9-2549.dor '`. - • . :
R.
Plan Submittal
Job Site
Owners N
Number, Street, or PO
City, State, Postal C
Owners Phone Nur
Owners E -Mail Add
Project Manager's
Project Manager's Phone N
Project Managers Email Ai
Builder / C:onba
Number, Street or PO
City, State, Postal C
Project Square
Building Permit Number(!
Project Description: SFR
Exempt 0
(Materials may contain hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
tel 8/20/2015 - RECEIVED
55930 Pebble Beads Drive
vonell & Francis Jacobson
AUG 2 8 2015
16 wren Cresent CITY OF Li! QUINTA
Brandon, Manitoba, Canada.R78056 COMMUNITY DEVELOPMENT
204729-1070
David Heller
760-285-9498
hetlerrenomail com.
Heller Renovations & Repair
67,385 Quijo Rd
Cathedra (City, Ca.. 92234
approx. 3470 sq it
City Approval By
Date of City Approval jdZ29/I
To Be Discarded:
Product
Tons
Trash
14.50 Not recyclable
Produej;.
Tons
Asphalt
0.00 Recyclable
Masonry (broken)
0.00
Bdck/Block
0.00 Recyclable
Plaster
3.75
Cardboard
0.00 Recyclable
Scrap Metal
0.00
Commingled
0.00 Recyclable
Tile (floor)
0.25
Concrete
15.00 Recyclable
Tile (roof)
0.50
Drywall
1.25 Recyclable
Wood
4.25
Donated / Reuse'
0.00 Recyclable
Landscape Debris
0.00
'Describe Items
Totals: Rec cle Trash Projected Diversion:
20.ul 14.5 63.29%
I understand It is the property owners responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. l hereby certify that completion, implementation and adherence of the
Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobsite waste is
diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining
materials generated from the first day of the project through the completion of the project in accordance with this plan. This
DMP is issued in the name of the property owner(s) and shall remain their property throughout the construction and/or
demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still
issued In the name of the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the
OMP are adhered to. The property owners) and general contractor shall be kept informed of the diversion progress through
onth repo . If self -hauling, all ref u vial from this project site must be taken to an approved recycler or transfer
er, Devd1operIProjectManager/Sup ri Date
)M ,
YOUNG
ENGINEERING`:
Letter of.Transmittal` F
s
To: City of La Quinta Today's Date::
9-14-15
78-495 Calle Tampico City Due Date:
'; 9-11-15
La Quinta, CA 92253 Project Address: . ,, 55-930 Pebble
Beach
Attn: Kay - Plan Check #
'' BRES 2015-0282
Submittal: 15i .
El J 40
® 2nd
':. 5m
❑ 3rd'.
❑ ;:Other.
r
We are forwarding: ® By Messenger ❑ "By Mail (Fed Ex or UPS)
❑ Your Pickup,.
Includes: # Of Descriptions: Includes
# Of
Descriptions
Copies:
Copies
❑ Structural Plans
®" - 1
Revised Structural Plans
® 1 Structural Calculations
❑ '„`
Revised Struct. Calcs .
Truss Calculations Floor
® 2and
`
❑
,.
Revised Truss
Roof
❑ Soils Report
p 1
Revised Soils Report
❑ Structural Comment List
' ❑
Approved Structural Plans
® 1 Redlined Structural Plans
❑
Approved Structural Calcs
❑ Redlined Structural Calcs
❑
Approved Truss Calcs
❑ Redlined Truss Calcs.EJ
x' '
Approved Soils Report -
❑ Redlined Soils Reports
O`
Other.
Comments: Structural content is approvable.
If you have any questions, please call.
Time = 1 HR
This Materia-l Sent for:
f "�
❑ Your Files®�
Per Your Request
❑ Your Review
❑ -`Approval
❑ Checking
❑ At the request of:
Other: ❑
By:. Kathryn Samuels
Palm Desert Office: ® (760) 772-5107
Other: ❑'
ri ,
BUILDING -ENERGY ANALYSIS REPORT I I
PROJECT:
Jack Jacobson
55930 Pebble Beach Dr. - A.P.N. 775-130-020
La Quinta, Ca 92253
Project Designer:
GABRIEL LUJAN & ASSOCIATES
36947 Cook St. Suite 104
Palm Desert, Ca
(760) 578-8545
Report Prepared by:
Santiago Lopez-Ocampo
Santiago Lopez-Ocampo
P.O. Box 1018
La Quinta, Ca 92247
760.485.8927
CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
APPROVED
FOR CONSTRUCTION
DATE _BY
RECEIVED::.,..
Job Number: a;
�,.�: RECENE ;
AUG 2 8 2015 LQ062215;
CITY OF LA QUINTA "'u . JUL 7 2015
COMMUNITY DEVELOPMENT Date:, ;
CITY OF LA QUINTA '.
rs COMMUNITY
7/15/2015 ' • `�`:� DEVELOPMENT
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval.arfd is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC — www.energysoft.com.
/D: LQ062215
TABLE OF CONTENTS
T
Cover Page
Table of Contents
Form CF -1 R -PRF -01 -E Certificate of Compliance
Form RMS -1 Residential Measures Summary
Form MF -1 R Mandatory Measures Summary
HVAC System Heating and Cooling Loads Summary
1
2
3
13
14
18
EnergyPro 6.6 by EnergySoft _ Job Number. ID: LQ062215 User Number: 5732 .
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis
Input File Name: Jacobson w-Garage.xml
CFI R -PRF -01
Page 1 of 10
GENERAL INFORMATION
01
01
Project Name Jack Jacobson
02
Yid t�ti�v� �..3 n 6r P� i�
This building incorporates fe tuMres.tthat require fie�d�esiing ajnd/orov�erifiea�tib a underrlhe supervision of a CEC-approved HERS
02
Calculation Description Title 24 Analysis
*ratetr provider.
03
03
Project Location 55930 Pebble Beach Dr. - A.P.N. 775-130-020
Compliance Margin
Ark
04
City La Quinta
05
Standards Version Compliance 2015
06
Zip Code 92253
07
Compliance Manager Version BEMCmpMgr 20134 (744)
08
Climate Zone CZ15
09
Software Version EnergyPro 6.6
10
Building Type Single Family
11
Front Orientation (deg/Cardinal) 315
12
Project Scope Newly Constructed
13
Number of Dwelling Units 1
14
Total Cond. Floor Area (ft) 4354
15
Number of Zones 2
16
Slab Area (ft2) 4354
17
Number of Stories 1
18
Addition Cond. Floor Area N/A
19
Natural Gas Available Yes
20
Addition Slab Areat'60)' N/A
21
Glazing Percentage (%) 17.2%
COMPLIANCE RESULTS
01
Building Complies With `Compute"r Performa ce
rna�. .tea
02
Yid t�ti�v� �..3 n 6r P� i�
This building incorporates fe tuMres.tthat require fie�d�esiing ajnd/orov�erifiea�tib a underrlhe supervision of a CEC-approved HERS
06
o by agcertified�HERS
*ratetr provider.
03
.i, . i. ii .i
This building incorporates one ormore Special Features„shownbelow;
Compliance Margin
Ark
Space Heating
2.05
2.46
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
ENERGY USE SUMMARY
04
05
06
07
08
Energy Use (kTDV/ft2-yr)
Standard Design
Proposed Design
Compliance Margin
Percent Improvement
Space Heating
2.05
2.46
-0.41
-20.0%
Space Cooling
78.72
72.07
6.65
8.4%
IAQ Ventilation
0.75
0.75
0.00
0.0%
Water Heating
5.89
7.23
-1.34
-22.8%
Photovoltaic Offset
----
0.00
0.00
----
Compliance Energy Total
87.41
82.51
4.90
5.6%
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson
Calculation Description: Title 24 Analysis
Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Input File Name: Jacobson w-Garage.xml
REQUIRED SPECIAL FEATURES
The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis.
• Ceiling has high level of insulation
• Window overhangs and/or fins
• Exposed slab floor in conditioned zone
HERS FEATURE SUMMARY
CF1 R -PRF -01
Page 2 of 10
The following is a summary of the features that must be field -verified by a certified HERS Rater as a condition for meeting the modeled energy performance for this computer analysis. Additional detail is
provided in the building components tables below.
Building -level Verifications:
• IAQ mechanical ventilation
Cooling System Verifications:
• Minimum Airflow
• Verified SEER
• Refrigerant Charge
• Fan Efficacy Watts/CFM.
HVAC Distribution System Verifications:
• Duct Sealing
• Low -leakage Air Handling Umt`4;;t
Domestic Hot Water System Verifications: 7 �-
• Pipe Insulation, All Lines"
ENERGY DESIGN RATING 'f -
This is the sum of the annual TDV energy consumption fof energy use.components. included in the-p�rformance compliance approachsfof• the'Standard Design Building (Energy Budget) and the annual
TDV energy consumption for lighting and components not regulated bTitle 24; PArt 6 (such as do esti applf and s)
nces coni surner elec ronf and accounting for the annual TDV energy offset by an
on-site renewable energy system.
Reference Energy Use ::Energy Design Rating
Margin Percent Improvement
Total Energy (kTDV/f2-yr)' 125.32 120.42:
4.90 3.9%
• includes calculated Appliances and Miscellaneous Energy Use (AMEU)
BUILDING - FEATURES INFORMATION
01
02
03
04
05
06
07
Project Name
Conditioned Floor Area (ft2)
Number of Dwelling
Units
Number of Bedrooms
Number of Zones
Number of Ventilation
Cooling Systems
Number of Water
Heating Systems
Jack Jacobson
4354
1
3
2
0
1
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaiCERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis
Input File Name: Jacobson w-Garage.xml
CF1 R -PRF -01
Page 3 of 10
ZONE INFORMATION
01
02
03
04
05
06
07
Zone Name
Zone Type
HVAC System Name
Zone Floor Area
(ft2)
Avg. Ceiling
Height
Water Heating System 1
Water Heating System 2
Whole House
Conditioned
HVAC Systeml
3470
9
DHW Sys 1
Window & Door Area (ft2)
Garages
Conditioned
HVAC System2
884
9
DHW Sys 1
605
OPAQUE SURFACES
01
02
03
04
05
06
07
08
Name
Zone
Construction
Azimuth
Orientation Gross Area (W)
Window & Door Area (ft2)
Tilt (deg)
Ri/SW
Whole House
R-21 Wall
0
specify -
605
52.3
90
Re/SE
Whole House
R-21 Wall
90
specify -
293.8
48
90
Re/E
;Who.le House
R-21 Wall
90
specify -
115
64
90
Re/S
<- . `Whole Houser .
R-21 Wall
90
- specify -
402.8
280
90
Le/NE'
Whole House
R-21 Wall
_ 45
Left
815.3
109.3
90
Fr/NW -Drywall
Whole Fosse sIR-21
Wall Drywall
0
specify - r
264
90
Fr/NW,Th�oleNHouseR-21Wall
w 3�5
Fron[f w
396
164.008
90
Roof
Whole>House R 49 Roof.Attic w/Radiani
WWW oo
4 y,,. .
3470
Ri/SW 2
GaragesA 1Z
VR 21 Wall='
" ''0, I
specify -1
380
200
90
Le/NE 2
Garages
R-21 Wall
45
Left
398.3
24
90
Fr/NW 2
Garages
R-21 Wall
315
Front
396
30
90
Roof 2
Garages
R-49 Roof Attic w/Radiant
884
ATTIC
01
02
03
04
05
06
07
08
Name
Construction
Type
Roof Rise
Roof Reflectance
Roof Emittance
Radiant Barrier
Cool Roof
Attic Whole House
Attic RoofWhole House
Ventilated
0.2
0.1
0.85
Yes
No
Attic Garages
Attic RoofGarages
Ventilated
0.2
0.1
0.85
Yes
No
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis
Input File Name: Jacobson w-Garage.xml
CF1 R -PRF -01
Page 4 of 10
WINDOWS
01
02
03
04
05
06
07
08
09
10
Name
Type
Surface (Orientation -Azimuth) Width (ft) Height (ft)
Multipli
er
Area
(ft2)
U -factor
SHGC
Exterior Shading
5020 M -Bath
Window
Ri/SW (- specify --0)
----
----
1
10.0
0.27
0.19
Insect Screen (default)
2626 M -Bath
Window
Ri/SW (- specify --0)
----
----
1
6.3
0.23
0.21
Insect Screen (default)
3060 M -Bed
Window
Ri/SW (- specify -0)
----
----
1
18.0
0.27
0.19
Insect Screen (default)
3060 M -Bed 2
Window
Ri/SW (- specify --0)
----
----
1
18.0
0.27
0.19
Insect Screen (default)
6060 M -Bed
Window
Re/SE (- specify -90)
----
----
1
36.0
0.27
0.19
Insect Screen (default)
6020 Powder
Window
Re/SE (- specify --90)
----
----
1
12.0
0.27
0.19
Insect Screen (default)
8080 SGD MBed
Window
Re/E (- specify --90)
8.0
8.0
1
64.0
0.26
0.17
Insect Screen (default)
60100 Great Room
Window
Re/S (- specify --90)
6.0
10.0
1
60.0
0.23
0.21
Insect Screen (default)
160100 Great Room
Windows
Re/S (- specify --90)
16.0
10.0
1
160.0
0.26
0.17
Insect Screen (default)
60100 Great Room 2
Window-:
Re/S specify 90
r is ( P fY - )
6.0
10.0
1
60.0
0.23
0.21
Insect Screen default
(default)
2626 Powder
Window e4 ""-r +'' - "'L6 NE (Left -45) • -
..
----
----
1
6.3
0.23
0.21
Insect Screen (default)
3060 Bed2
Window fi,. , 'Le/Nlra(Left-45) T* ----
1
18.0
0.27
0.19
Insect Screen (default)
3060 Bed2 2
Window
},r ;.= Le NE (Left_!45)
----
1198.0
0.27
0.19
Insect Screen (default)
4020 Bath2
Window
Le/NEJ; ft -45)
--'
-
1 t3;Qi
0.26
0.20
Insect Screen (default)
3060 Bed1
Window 7
Le/(Left 5)
;Z18.0
0.27
0.19
Insect Screen (default)
3060 Bed1 2
Window
Le/NE (Left -45) T
-
--
---
1
y18.0
0.27
0.19
Insect Screen (default)
4020 Bath1
Window
Le/NE (Left -45)
----
---
1
8.0
0.26
0.20
Insect Screen (default)
2660 Laundry
Window
Le/NE (Left -45)
----
----
1
15.0
0.27
0.19
Insect Screen (default)
5080 Dining
Window
Fr/NW (Front -315)
----
----
1
40.0
0.27
0.19
Insect Screen (default)
6028 Entry Transom
Window
Fr/NW (Front -315)
6.0
2.7
1.003
16.0
0.23
0.21
Insect Screen (default)
(2) 3080 Entry dr
Window
Fr/NW (Front -315)
6.0
8.0
1
48.0
0.26
0.17
Insect Screen (default)
6080 Den
Window
Fr/NW (Front -315)
---
----
1
48.0
0.27
0.19
Insect Screen (default)
6020 MBathr
Window
Fr/NW (Front -315)
----
1
12.0
0.27
0.19
Insect Screen (default)
6050 Garages
Window
Fr/NW 2 (Front -315)
--
1
30.0
1 0.27
0.19
Insect Screen (default)
Registration Number: 215-NO177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaiCERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis Input File Name: Jacobson w-Garage.xml
CFI R -PRF -01
Page 5 of 10
DOORS
01
02
03
04
Name
Side of Building
Area (ft2)
U -factor
9080
Ri/SW 2
72.0
0.18
16080
Ri/SW 2
128.0
0.18
3080
Le/NE 2
24.0
0.50
OVERHANGS AND FINS
01
02
03 04 1
05
1 06
07
08 09
10
11
1 12 1
13
14
Overhang
Left Fin
Right Fin
Window
Depth,&
Left
Dist Up Extent
Right
Extent
Flap Ht.
Depth
Top Up DistL
Bot Up
Depth
Top Up
Dist R
Bot Up
8080 SGD MBed
4: ;
0.1 1
1
0
0
0 0
0
36
0
1
0
60100 Great Room
1o.1.11 0.1 10
10
0
0
0 0
0
0
0
0
0
160100 Great Room
- ` ' "10
,�. �. _
=.0:1 - 10 10
0
10
0 8
0
0
0
0
0
60100 Great Room 2
''"•,
0 -; 10
.r "+°'� r
10
.r.°�°"'h
0 10
�'."`°�. � �.'.a dam'
0 1
�`t
0
0
0
0
0
6028 Entry Transom
i.*8 �� ,n: 4 ' 1e
y 0
0
0 0,
0
9
0
1
0
(2) 3080 Entry dr
11
3
3 0 0. '
0
9
0
1
0
MEMV HERS PROVIDER,
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFIR-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis Input File Name: Jacobson w-Garage.xml
CF1 R -PRF -01
Page 6 of 10
OPAQUE SURFACE CONSTRUCTIONS
01
02
03
04
05
06
07
0214
03
104 1
U, If* 05
Total Cavity
Winter Design
Name
Construction Name
Surface Type
Construction Type
Framing
R -value
U -value
Assembly Layers
Whole House
3470
0.1
None
0.8
No
• Cavity/ Frame: no insul. / 2x4 Top Chrd
Garages
884
0.1
2x4 Top Chord of Roof Truss @ 24
0
No
Roof Deck: Wood Siding/sheathing/decking
Attic RoofWhole House
Attic Roofs
Wood Framed Ceiling
in. O.C.
none
0.644
Roofing: Light Roof (Asphalt Shingle)
• Inside Finish: Gypsum Board
• Cavity / Frame: R-21 / 2x6
• Exterior Finish: Wood
R-21 Wall
Exterior Walls
Wood Framed Wall
2x6 @ 16 in. O.C.
R 21
0.066
Siding/sheathing/decking
• Inside Finish: Gypsum Board
• Cavity/Frame: R-21 /2x6
R-21 Wall - Drywall
Exterior Walls
Wood Framed Wall
2x6 @ 16 in. O.C.
R 21
0.066
• Exterior Finish: Wood
Siding/sheathing/decking
a>"<
Inside Finish: Gypsum Board
Ceilings (below
Cavity/Frame: R-9.1 /2x4
R-49 Roof Attic w/Radiant
,attic),
;;Wood Framed Ceiling
2x4 @ 24 in. O.C.
R 49
0.020
Over Floor Joists: R-39.9 insul.
¢Y
2x4 Top Chord Trussr@2
Cavity/ Frame: no insul. / 2x4 Top Chrd
Attic RoofGara
Attic Roofs
"Wood FrameddCCeilin""
of:Roof
O.C: 41
Roof Deck: Wood Siding/sheathing/decking
es
in..
none
0:644
Roofing: Light Roof (Asphalt Shingle)
SLAB FLOORS
ry'NINAf
"r m,' Iftp
tv
40 t� ; -WWI *0
05 06
Name
01
0214
03
104 1
U, If* 05
06
07
Name
Zone
Area (ft2)
Perimeter (ft)
Edge Insul. R -value & Depth
Carpeted Fraction
Heated
Exposed
Whole House
3470
0.1
None
0.8
No
Slab -on -Grade
Garages
884
0.1
None
0
No
BUILDING ENVELOPE - HERS VERIFICATION
01 . 02 03 04
Quality Insulation Installation (QII) Quality Installation of Spray Foam Insulation Building Envelope Air Leakage ACH @ 50 Pa
Not Required Not Required Not Required ---
WATER HEATING SYSTEMS
01
02
03
04
05 06
Name
System Type
Distribution Type
Water Heater
Number of Heaters Solar Fraction (%)
DHW Sys 1 - 1/2
DHW
(HERS req'd) Pipe Insulation, All
Lines
DHW Heater 1
2 .0%
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaiCERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis Input File Name: Jacobson w-Garage.xml
CF1 R -PRF -01
Page 7 of 10
WATER HEATERS
01
02
03
04
05
06
07
08
Name
Heater Element Type
Tank Type
Tank Volume
(gal)
Energy Factor or
Efficiency
Input Rating
Tank Exterior
Insulation
R -value
Standby Loss
(Fraction)
DHW Heater 1
Natural Gas
Small Storage
50
0.62
37000-Btu/hr
0
0
WATER HEATING - HERS VERIFICATION
01
02
03
04
05
06
07
Name
Pipe Insulation
Parallel Piping
Compact Distribution
Point -of Use
Recirculation
Control
Central DHW
Distribution
DHW Sys 1 - 1/2
Pipe Insulation, All Lines
/
___
_
Pipe Insulation, All
Lines
' O.t lr Heating'and Cooling `1
Systeme' !heating
W
SPACE CONDITIONING SYSTEMS 1, �
.. .1
01
°� i :.-�,f
02 �.-
03
04
05
06
SC Sys Name
Heating Unit Name
Cooling Unit Name
Fan Name
Distribution Name
Sys Name
S sternTyPe
5tl . I
iun Unit
irt a«a�r
eairKIK
Colin Uit'NmeSC
Fan Name
Distribution Name
1 �:
HVAC Systeml �,r
' O.t lr Heating'and Cooling `1
Systeme' !heating
Component 1
"a )
Co g Component
HVAC Fan 1
Air Distribution System 1
#
SPACE CONDITIONING SYSTEMS
01
02
03
04
05
06
SC Sys Name
System Type
Heating Unit Name
Cooling Unit Name
Fan Name
Distribution Name
:Heat Pump System 2:::2
Heat Pump Heating and
Cooling System
Heat Pump System 2
Heat Pump System 2
None
None
HVAC - HEATING UNIT TYPES
01 02 03
Name Type Efficiency
Heating Component 1 CntrlFurnace - Fuel -fired central furnace 94.1 AFUE
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis
Input File Name: Jacobson w-Garage.xml
CF1 R -PRF -01
Page 8 of 10
HVAC - HEAT PUMPS
01
02
03 04 05
06 07
08
09
10
(i
Verified Airflow
a-; x,
Requved
Efficiency
Heating
Cooling
Zonally
Muitispeed
HERS
Name
Type
HSPF/COP Cap 47 Cap 17
SEER EER
Controlled
Compressor
Verification
Heat Pump System 2
DuctlessHeatPump
8.29600
Cooling Component
1 -hers -cool
6700
14.3
11.8
No
No
Heat Pump System
atPump
Ductlessi_:'�
11.8
14.3
Not Zonal
Single Speed
Cooling Component
2 -hers -cool
HVAC - COOLING UNIT TYPES
01
02
03 04
05
06
07
Name
Cooling Component 1 -hers -cool
(i
Verified Airflow
a-; x,
Requved
Efficiency
Verified=EER
r= �ro_,h�
Required t
Multi -speed
Verified Refrigerant
9
Charge
Required
Name-
System Type
EER SEER
Zonally Controlled
Compressor
HERS Verification
Cooling Component 1
SplitAirCond
11.7
14.2
Not Zonal
Single Speed
Cooling Component
1 -hers -cool
no ducts
None
atPump
Ductlessi_:'�
11.8
14.3
Not Zonal
Single Speed
Cooling Component
1 -hers -cool
HVAC COOLING - HERS VERIFICATIOWsy""
01--"2;-AL—,
11iN .. '�
... :�
4
04
05
06
Name
Cooling Component 1 -hers -cool
(i
Verified Airflow
a-; x,
Requved
Ai'tflow Targr et
350? t U
Verified=EER
r= �ro_,h�
Required t
Verified SEER
� Required
Verified Refrigerant
9
Charge
Required
Heat Pump System 2 -hers -cool
Not Required
Air Distribution System 1
Not Required
Not Required
Not Required
HVAC - DISTRIBUTION SYSTEMS
01
02
03
04
05
06
07
Name
Type
Duct Leakage
Insulation R -value
Duct Location
Bypass Duct
HERS Verification
Air Distribution System 1
DuctsAttic
Specified Lower Leakage
Target
8
Attic
None
Air Distribution System
1 -hers -dist
Not Required
Not Required
Required
no ducts
None
HVAC DISTRIBUTION - HERS VERIFICATION
01
02
03
04
05
06
07
08
Name
Duct Leakage
Verification
Duct Leakage
Target (%)
Verified Duct
Location
Verified Duct
Design
Buried
Ducts
Deeply Buried
Ducts
Low -leakage
Air Handler
Air Distribution System 1 -hers -dist
Required
6.0
Not Required
Not Required
Not Required
Not Required
Required
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: Ca10ERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson
Calculation Description: Title 24 Analysis
Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Input File Name: Jacobson w-Garage.xml
CFI R -PRF -01
Page 9 of 10
HVAC -FAN SYSTEMS
01 02 03 04
Name Type Fan Power (Watts/CFM) HERS Verification
HVAC Fan 1 Single Speed PSC Furnace Fan 0.58 HVAC Fan 1 -hers -fan
HVAC FAN SYSTEMS - HERS VERIFICATION
01 02 03
Name Verified Fan Watt Draw Required Fan Efficiency (Watts/CFM)
HVAC Fan 1 -hers -fan Required 0.58
IAQ (Indoor Air Quality) FANS 4
01
02
03
04
05
06
Dwelling Unit
' 3 ?
yt�IAQ;CFM_ _
IAQ Watts/CFM
IAQ Fan Type
IAQ Recovery
Effectiveness(%)
HERS Verification
SFam IAQVentRpt
'�;a 73.54 .'='
0.25
Default
0
Required
�nL*
Is -
R.
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaICERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD
Project Name: Jack Jacobson Calculation Date/Time: 17:23, Wed, Jul 15, 2015
Calculation Description: Title 24 Analysis
Input File Name: Jacobson w-Garage.xml
CFI R -PRF -01
Page 10 of 10
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Santiago Lopez-Ocampo
Company:
Signature Date:
Santiago Lopez-Ocampo
2015-07-15 17:38:55
Address:
CEA/HERS Certification Identification (If applicable):
P.O. Box 1018
NA
City/State/Zip:
Phone:
La Quinta, CA 92247
760 485 8927
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. I am eligible under Division 3 of the Business'and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance.
2. 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of
Regulations.
3. The building design features or system design features identified:on.this'CeRificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitteci "' he enforcementt-agency fors approval,with this-buiilding permit application.
Responsible Designer Name:
8
`�La Responsible'Designer Signature: .
C.
Santiago Lopez-Ocampo
Wtr,
Company:'
Date Signed:
07
Santiago Lopez-Ocampo
20 5 157 .38:55'
Address:
License:
P.O. Box 1018
NA
City/State/Zip:
Phone:
La Quinta, CA 92247
760 485 8927
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the
information.
Registration Number: 215-N0177352B-000000000-0000 Registration Date/Time: 2015-07-15 17:38:55 HERS Provider: CaiCERTS inc.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-07082015-744 Report Generated at: 2015-07-15 17:24:32
RESIDENTIAL MEASURES SUMMARY
RMS -1
Project Name
Jack Jacobson
Building Type m Single Family ❑ Addition Alone
❑ Multi Family ❑ Existing+ Addition/Alteration
Date
7/15/2015
Project Address
55930 Pebble Beach Dr. - A.P.N. 775-130
California Energy Climate Zone
CA Climate Zone 15
Total Cond. Floor Area
4,354
Addition
n/a
# of Units
1
INSULATION
Construction Type
Area
Cavity (ft)
Special Features Status
Slab Unheated Slab -on -Grade
- no insulation 4,354
Perim = 0'
New
Wall Wood Framed
R 21 3,359
New
Wall Wood Framed
R 21 264
New
Roof Wood Framed Attic
R49 4,354
New
Door Opaque Door
Insu/ 200
New
Door Opaque Door
- no insulation 24
New
FENESTRATION
Orientation
I Total Area: 748 Glazing Percentage: 17.2`%
U -Fac SHGC Overhang Sidefins
New/Altered Average U -Factor: 0.26
Exterior Shades Status
-Area(ft)
Front (N) 46.0
0.270
0.19 none
none
Bug Screen New
Front (N) 6.3
0.230
0.21 none
none
Bug Screen New
Left (E) 48.0
0.270
0.19 none
none
Bug Screen New
Left (E) 64.0
0.260
0.17 4.0
0.00136.00
Bug Screen New
Left (E) 60.0
0.230
0.21 10.0
none
Bug Screen New
Left (E) 160.0
0.260
0.17 10.0
10.00/0.00
Bug Screen New
Left (E) 60.0
0.230
0.21 10.0
10.00/0.00
Bug Screen New
Left (NE) 6.3
0.230
0.21 none
none
Bug Screen New
Left (NE) 87.0
0.270
0.19 none
none
Bug Screen New
Left (NE) 16.0
0.260
0.20 none
none
Bug Screen New
Front (NV1O 130.0
0.270
0.19 none
none
Bug Screen New
Front (NM 16.0
0.230
0.21 8.0
0.00/9.00
Bug Screen New
Front (NV19 48.0
0.260
0.17 8.0
0.00/9.00
Bug Screen New
HVAC SYSTEMS
Qty. Heating
Min. Eff
Cooling
Min. Eff
Thermostat Status
2 Central Furnace
94% AFUE
Split Air Conditioner
14.2 SEER
Setback
New
1 Split Heat Pump
8.20 HSPF
Split Heat Pump
14.3 SEER
Setback
New
HVAC DISTRIBUTION
Location Heating
Cooling Duct Location
Duct
R -Value Status
HVAC System Ducted
Ducted Attic
8.0
New
HVAC System Ductless / with Fan
Ductless n/a
n/a
New
WATER HEATING
Qty. Type
Gallons Min. Eff
Distribution Status
2 Small Storage Gas
50
0.62
All Pipes Ins (HERS) New
EnergyPro 6.6 by EnergySoft User Number: 5732
RunCode: 2015-07-15717:25:00
/D: LQ062215
Pae 13 of 19
2013 Low -Rise Residential Mandatory Measures Summary
NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the
compliance approach used. Exceptions may apply. Review the respective code section for more information.
Building Envelope Measures:
§ 1 10.6(a)1:
Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
§ 110.6(a)5:
Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain
Coefficient (SHGC), and infiltration that meets the requirements of § 10-111(a).
§ 110.7:
Exterior doors and windows are weatherstripped; all joints and penetrations are caulked and sealed.
§ 110.8(a):
Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on the CF2R.
1 10'8(1)'
The thermal emittance and aged solar reflectance values of the cool roofing material meets the requirements of §I 10.8(1) when the
installation of a cool roof is specified on the CFI R.
§ 110.80):
A radiant barrier shall have an emittance of 0.05 or less when the installation of a radiant barrier is specified on the CFIR.
Minimum R-30 insulation in wood -frame ceiling; or the weighted average U -factor shall not exceed 0.031. Minimum R-19 in a
§ 150.0(a):
rafter roof alteration. Attic access doors shall have permanently attached insulation using adhesive or mechanical fasteners. The
attic access shall be gasketed to prevent air leakage.
§I50.0(b):
Loose fill insulation shall conform with manufacturer's installed design labeled R -value.
§ I50.0(c):
Minimum R-13 insulation in 2x4 inch wood framing wall or have a U -factor of 0.102 or less (R-19 in 2x6 or 0.074 maximum U -
factor).
§ 150.0(d):
Minimum R-19 insulation in raised wood -frame floor or 0.037 maximum U -factor.
In Climate Zones 14 and 16 a Class 11 vapor retarder shall be installed on the conditioned space side of all insulation in all exterior
§ I50.0(g)1:
walls, vented attics and unvented attics with air -permeable insulation.
In Climate Zones 1-16 with unvented crawl spaces the earth floor of the crawl space shall be covered with a Class I or Class II
§ 150.0(g)2:
vapor retarder.
In a building having a controlled ventilation crawl space, a Class 1 or Class II vapor retarder shall be placed over the earth floor of
§ 150.0(8)3:
the crawl space to reduce moisture entry and protect insulation from condensation, as specified in the exception to Section
150.0(d).
§ 150.0(1):
Slab edge insulation shall: have a water absorption rate, for the insulation material alone without facings, no greater than 0.3%;
have water vapor permeance rate is no greater than 2.0 perm/inch, be protected from physical damage and UV light deterioration;
and when installed as part of a heated slab floor meets the requirements of § 110.8( ).
§ 150.0 (q)'
Fenestration, including skylights, separating conditioned space from unconditioned space or outdoors shall have a maximum U -
factor of 0.58; or the weighted average U -factor of all fenestration shall not exceed 0.58.
Fireplaces, Decorative Gas Appliances and Gas Log Measures:
§ 150.0(e)I A:
Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§ I50.0(e)I B:
Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is
equipped with a readily accessible, operable, and tight -fitting damper or a combustion -air control device.
§ 150.0(e) I C:
Masonry or factory -built fireplaces have a flue damper with a readily accessible control.
§I50.0(e)2:
Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside
of the building, are prohibited.
Space Conditioning, Water Heating and Plumbing System Measures:
§ 110.0-§ 110.3:
HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified to the Energy Commission.
§ 1 10.3(c)5:
Water heating recirculation loops serving multiple dwelling units meet the air release valve, backflow prevention, pump isolation
valve, and recirculation loop connection requirements of § 110.3(c)5.
Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appli-
§110.5:
ances without an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool
and spa heaters.
§I50.0(h)1:
Heating and/or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA using design conditions specified
in § 150.0(h)2.
§ 150.0(h)3A:
Installed air conditioner and heat pump outdoor condensing units shall have a clearance of at least five feet from the outlet of any
dryer vent.
§ 150.0(i):
Heating systems are equipped with thermostats that meet the setback requirements of § 110.2(c).
§150.00)1 A:
Storage gas water heaters with an energy factor equal to or less than the federal minimum standards shall be externally wrapped
with insulation having an installed thermal resistance of R-12 or greater.
§150.00)1 B:
Unfired hot water tanks, such as storage tanks and backup storage tanks for solar water -heating systems, have R-12 external
insulation or R-16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank.
For domestic hot water system piping, whether buried or unburied: the first 5 feet of hot and cold water pipes from the storage
tank, all piping with a nominal diameter of 3/4 inch or larger, all piping associated with a domestic hot water recirculation system
§ 150.00)2A:
regardless of the pipe diameter, piping from the heating source to storage tank or between tanks, piping buried below grade, and
all hot water pipes from the heating source to kitchen fixtures must be insulated according to the requirements of TABLE 120.3-
A.
§ 150.00)2B:
All domestic hot water pipes that are buried below grade must be installed in a water proof and non -crushable casing or sleeve
that allows for installation, removal, and replacement of the enclosed pipe and insulation.
2013 Low. -Rise Residential Mandatory Measures Summary
§I50.00)2C:
Pipe for cooling system lines shall be insulated as specified in §I50.0Q)2A. Piping insulation for steam and hydronic heating
systems or hot waters stems with pressure > 15 psig shall meet the requirements in TABLE 120.3-A.
§ 150.00)3:
Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind.
Insulation exposed to weather shall either be rated for outdoor use or installed with a cover suitable for outdoor service. For
§150.00)3A:
example, protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation protected as specified or
painted with coating that is water retardant and provides shielding from solar radiation that degrades the material.
Insulation covering chilled water piping and refrigerant suction piping located outside the conditioned space shall have a Class I
§ 150.00)3B:
or Class 11 vapor retarding facing, or the insulation shall be installed at the thickness that qualifies as a Class I or Class 11 vapor
retarder.
Systems using gas or propane water heaters to serve individual dwelling units shall include: a 120V electrical receptacle within 3
feet of the water heater; a Category III or IV vent, or a Type B vent with straight pipe between the outside termination and the
§ 150.0(n)1:
space where the water heater is installed; a condensate drain that is no more than 2 inches higher than the base of the installed
water heater, and allows natural draining without pump assistance; and a gas supply line with a capacity of at least 200,000
Btu/hr.
§ 150.0(n)2:
Recirculating loops serving multiple dwelling units shall meet the requirements of §I 10.3(c)5.
§ I50.0(n)3:
Solar water -heating systems and collectors shall be certified and rated by the Solar Rating and Certification Corporation (SRCC)
or by a testing agency approved by the Executive Director.
Ducts and Fans Measures:
All air -distribution system ducts and plenums installed are sealed and insulated to meet the requirements of CMC §601.0, §602.0,
§603.0, §604.0, §605.0 and ANSI/SMACNA-006-2006 HVAC Duct Construction Standards Metal and Flexible 3rd Edition.
Supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-6.0 (or higher if required by CMC
§605.0) or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing
(RA3.1.4.3.8). Connections of metal ducts and inner core of flexible ducts are mechanically fastened. Openings shall be sealed
§1 50.0(m)] :
with mastic, tape, or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or
aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than %< inch, the
combination of mastic and either mesh or tape shall be used. Building cavities, support platforms for air handlers, and plenums
defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms
shall not be compressed to cause reductions in the cross-sectional area of the ducts.
Factory -Fabricated Duct Systems shall comply with specified requirements for duct construction, connections, and closures; joints
§ 150.0(m)2:
and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is
used in combination with mastic and draw bands.
§ 150.0(m)3-6:
Field -Fabricated Duct Systems shall comply with requirements for: pressure -sensitive tapes, mastics, sealants, and other
requirements specified for duct construction; duct insulation R -value ratings; duct insulation thickness; and duct labeling.
§ 150.0(m)7:
All fan systems that exchange air between the conditioned space and the outside of the building must have backdraft or automatic
dampers.
§I50.0(m)8:
Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers
except combustion inlet and outlet air openings and elevator shaft vents.
Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not
§ 150.0(m)9:
limited to the following: insulation exposed to weather shall be suitable for outdoor service. For example, protected by aluminum,
sheet metal, painted canvas, or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation.
§ 150.0(m)10:
Flexible ducts cannot have porous inner cores.
When space conditioning systems use forced air duct systems to supply conditioned air to an occupiable space, the ducts shall be
§ 150.0(m)1 1:
sealed and duct leakage tested, as confirmed through field verification and diagnostic testing, in accordance with Reference
Residential Appendix RA3.
Mechanical systems that supply air to an occupiable space through ductwork exceeding 10 feet in length and through a thermal
§ 150.0(m)l2:
conditioning component, except evaporative coolers, shall be provided with air filter devices that meet the requirements of
§I50.0(m)12.
Space conditioning systems that utilize forced air ducts to supply cooling to an occupiable space shall have a hole for the
placement of a static pressure probe (HSPP), or a permanently installed static pressure probe (PSPP) in the supply plenum. The
§I50.0(m)13:
space conditioning system must also demonstrate airflow> 350 CFM per ton of nominal cooling capacity through the return
grilles, and an air -handling unit fan efficacy <_ 0.58 W/CFM as confirmed by field verification and diagnostic testing, in
accordance with Reference Residential Appendix RA3.
"Zonally controlled central forced air cooling systems shall be capable of simultaneously delivering, in every zonal control mode,
§ 150.0(m)15:
an airflow from the dwelling, through the air handler fan and delivered to the dwelling, of >_ 350 CFM per ton of nominal cooling
capacity, and operating at an air -handling unit tan efficacy of. -5 0.58 W/CFM as confirmed by field verification and diagnostic
testing, in accordance with Reference Residential Appendix RA3.
All dwelling units shall meet the requirements of ASHRAE Standard 62.2. Neither window operation nor continuous operation of
§ 150.0(0):
central forced air system air handlers used in central fan integrated ventilation systems are permissible methods of providing the
Whole Building Ventilation.
§ 150.0(0)1 A:
Whole Building Ventilation airflow shall be confirmed through field verification and diagnostic testing, in accordance with
Reference Residential Appendix RA3.
Pool and Spa Heating Systems and Equipment Measures:
Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency
§ 110.4(a):
Regulations; an on-off switch mounted outside of the heater that allows shutting off the heater without adjusting the thermostat
setting; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating.
2013 Low -Rise Residential Mandatory Measures Summary
1 10.4(b)l :
Any pool or spa heating equipment shall be installed with at least 36 inches of pipe between filter and heater or dedicated suction
and return lines, or built-up connections for future solar heating.
§ 1 10.4(b)2:
Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
§ 1 10.4(b)3:
Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or pro -
rammed to run only during off-peak electric demand p2riods.
§ 110.5:
Natural gas pool and spa heaters shall not have a continuous burning pilot light.
§ 150.0(p):
Residential pool systems or equipment shall meet specified pump sizing, flow rate, piping, filters, and valve requirements.
Lighting Measures:
§ 110.9:
All lighting control devices and systems, ballasts, and luminaires shall meet the applicable requirements of §110.9.
§ 150.0(k) I A:
Installed luminaires shall be classified as high -efficacy or low -efficacy for compliance with § 150.0(k) in accordance with TABLE
150.0-A or TABLE 150.0-B, as applicable.
§I50.0(k)I B:
When a high efficacy and low efficacy lighting system are combined in a single luminaire, each system shall separately comply
with the applicable provisions of §150.0(k).
The wattage and classification of permanently installed luminaires in residential kitchens shall be determined in accordance with
§ 150.0(k)IC:
§ 130.0(c). In residential kitchens, the wattage of electrical boxes finished with a blank cover or where no electrical equipment has
been installed, and where the electrical box can be used for a luminaire or a surface mounted ceiling fan, shall be calculated as 180
watts of low efficacy lighting er electrical box.
§I50.0(k)I D:
Ballasts for fluorescent lamps rated 13 watts or greater shall be electronic and shall have an output frequency no less than 20 kHz.
Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no
§ 150.0(k) I E:
more than 5 watts of power per luminaire or exhaust fan as determined in accordance with § 130.0(c). Night lights do not need to
be controlled by vacancy sensors.
§ 150.0(k)I F:
Lighting integral to exhaust fans (except when installed by the manufacturer in kitchen exhaust hoods) shall meet the applicable
requirements of § 150.0(k).
§ I50.0(k)2A:
High efficacy luminaires must be switched separately from low efficacy luminaires.
§I50.0(k)2B:
Exhaust fans shall be switched separately from lighting systems.
§I50.0(k)2C:
Luminaires shall be switched with readily accessible controls that permit the luminaires to be manually switched ON and OFF.
§ I50.0(k)2D:
Controls and equipment are installed in accordance with manufacturer's instructions.
§ 150.0(k)2E:
No control shall bypass a dimmer or vacancy sensor function if the control is installed to comply with §I50.0(k).
§ 150.0(k)2F:
Lighting controls comply with applicable requirements of § 110.9.
An Energy Management Control System (EMCS) may be used to comply with dimmer requirements if: it functions as a dimmer
§ 150.0(k)2G:
according to § 110.9; meets Installation Certificate requirements of § 130.4; the EMCS requirements of § 130.5; and all other
requirements in § I50.0(k)2.
An Energy Management Control System (EMCS) may be used to comply with vacancy sensor requirements of § 150.0(k) if: it
§ 150.0(k)2H:
functions as a vacancy sensor according to § 110.9; meets Installation Certificate requirements of §130.4; the EMCS requirements
of §130.5; and all other requirements in § 150.0(k)2.
§ 150.0(k)2I:
A multiscene programmable controller may be used to comply with dimmer requirements of this section if it provides the
functionality of a dimmer according to § 110.9, and complies with all other applicable requirements in § I50.0(k)2.
§ 150.0(k)3A:
A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
Kitchen lighting includes all permanently installed lighting in the kitchen except internal lighting in cabinets that illuminate only
§ 150.0(k)3B:
the inside of the cabinets. Lighting in areas adjacent to the kitchen, including but not limited to dining and nook areas, are
considered kitchen lighting if they are not separately switched from kitchen lighting.
§ I50.0(k)4:
Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated
cabinet.
§ 150.0(k)5:
A minimum of one high efficacy luminaire shall be installed in each bathroom; and all other lighting installed in each bathroom
shall be high efficacy or controlled by vacancy sensors.
§ I50.0(k)6:
Lighting installed in attached and detached garages, laundry rooms, and utility rooms shall be high efficacy luminaires and
controlled by vacancy sensors.
§ I50.0(k)7:
Lighting installed in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, and utility rooms shall be high
efficacy, or shall be controlled by either dimmers or vacancy sensors.
Luminaires recessed into ceilings shall: be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other
nationally recognized testing/rating laboratory; have a label that certifies that the luminaire is airtight with air leakage less than 2.0
CFM at 75 Pascals when tested in accordance with ASTM E283; be sealed with a gasket or caulk between the luminaire housing
§ I50.0(k)8:
and ceiling, and shall have all air leak paths between conditioned and unconditioned spaces sealed with a gasket or caulk; and
allow ballast maintenance and replacement without requiring cutting holes in the ceiling.
For recessed compact fluorescent luminaries with ballasts to qualify as high efficacy for compliance with § I50.0(k), the ballasts
shall be certified to the Energy Commission to comply with the applicable requirements in § 110.9.
For single-family residential buildings, outdoor lighting permanently mounted to a residential building or other buildings on the
same lot shall be high efficacy, or may be low efficacy if it meets all of the following requirements:
i. Controlled by a manual ON and OFF switch that does not override to ON the automatic actions of Items ii or iii below; and
§ 150.0(k)9A:
ii. Controlled by a motion sensor not having an override or bypass switch that disables the motion sensor, or controlled by a
motion sensor having a temporary override switch which temporarily bypasses the motion sensing function and automatically
reactivates the motion sensor within 6 hours; and
iii. Controlled by one of the following methods:
2013 Low -Rise Residential Mandatory Measures Summary
a. Photocontrol not having an override or bypass switch that disables the photocontrol; or
b. Astronomical time clock not having an override or bypass switch that disables the astronomical time clock, and which is
programmed to automatically turn the outdoor lighting OFF during daylight hours; or
c. Energy management control system which meets all of the following requirements: At a minimum provides the functionality of
an astronomical time clock in accordance with § 110.9; meets the Installation Certification requirements in § 130.4; meets the
requirements for an EMCS in § 130.5; does not have an override or bypass switch that allows the luminaire to be always ON; and,
is programmed to automatically turn the outdoor lighting OFF during daylight hours.
For low-rise multifamily residential buildings, outdoor lighting for private patios, entrances, balconies, and porches; and outdoor
lighting for residential parking lots and residential carports with less than eight vehicles per site shall comply with one of the
§ 150.0(k)9B:
following requirements:
i. Shall comply with §I50.0(k)9A; or
ii. Shall comply with the applicable requirements in §110.9, §130.0, §130.2, §130.4, ¢140.7 and §141.0.
§I50.0(k)9C:
For low-rise residential buildings with four or more dwelling units, outdoor lighting not regulated by §I50.0(k)9B or 150.0(k)9D
shall comply with the applicable requirements in 110.9, 130.0, 130.2, 130.4, §140.7 and 141.0.
§ 150.0(k)9D:
Outdoor lighting for residential parking lots and residential carports with a total of eight or more vehicles per site shall comply
'110.9, '130.2,
with the applicable requirements in § 130.0, §130.4, § 140.7 and § 141.0.
§ 150.0(k)10:
Internally illuminated address signs shall comply with §140.8; or shall consume no more than 5 watts of power as determined
according to §I30.0(c).
§I50.0(k)1 l:
Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for
nonresidential garages in § 110.9, §130.0, § 130.1, §130.4, § 140.6, and § 141.0.
In a low-rise multifamily residential building where the total interior common area in a single building equals 20 percent or less of
§ 150.0(k) I2A:
the floor area, permanently installed lighting for the interior common areas in that building shall be high efficacy luminaires or
controlled by an occupant sensor.
In a low-rise multifamily residential building where the total interior common area in a single building equals more than 20
percent of the floor area, permanently installed lighting in that building shall:
§I50.0(k)l2B:
i. Comply with the applicable requirements in §110.9, §130.0, §130.1, §140.6 and §141.0; and
ii. Lighting installed in corridors and stairwells shall be controlled by occupant sensors that reduce the lighting power in each
space by at least 50 percent. The occupant sensors shall be capable of turning the light fully On and Off from all designed paths of
ingress and egress.
Solar Ready Buildings:
Single family residences located in subdivisions with ten or more single family residences and where the application for a
§1 10.10(a)1:
tentative subdivision map for the residences has been deemed complete, by the enforcement agency, on or after January 1, 2014,
shall comply with the requirements of § 110.10(b) through § 110.10(e).
§I 10.10(a)2:
Low-rise multi -family buildings shall comply with the requirements of §I10.10(b) through §I10.10(d).
The solar zone shall have a minimum total area as described below. The solar zone shall comply with access, pathway, smoke
ventilation, and spacing requirements as specified in Title 24, Part 9 or other Parts of Title 24 or in any requirements adopted by a
local jurisdiction. The solar zone total area shall be comprised of areas that have no dimension less than 5 feet and are no less than
80 square feet each for buildings with roof areas less than or equal to 10,000 square feet or no less than 160 square feet each for
§1 10.10(b)l :
buildings with roof areas greater than 10,000 square feet.
For single family residences the solar zone shall be located on the roof or overhang of the building and have a total area no less
than 250 square feet. For low-rise multi -family buildings the solar zone shall be located on the roof or overhang of the building or
on the roof or overhang of another structure located within 250 feet of the building or on covered parking installed with the
building project and have a total area no less than 15 percent of the total roof area of the building excluding any skylight area.
§ 1 10.10(b)2:
All sections of the solar zone located on steep -sloped roofs shall be oriented between 110 degrees and 270 degrees of true north.
§1 10.10(b)3A:
No obstructions, including but not limited to, vents, chimneys, architectural features, and roof mounted equipment, shall be
located in the solar zone.
Any obstruction, located on the roof or any other part of the building that projects above a solar zone shall be located at least twice
§ 110.10(b)3B:
the distance, measured in the horizontal plane, of the height difference between the highest point of the obstruction and the
horizontal projection of the nearest point of the solar zone, measured in the vertical plane.
§ 1 10.10(b)4:
For areas of the roof designated as solar zone, the structural design loads for roof dead load and roof live load shall be clearly
indicated on the construction documents.
The construction documents shall indicate: a location for inverters and metering equipment and a pathway for routing of conduit
§ 1 10.10(c):
from the solar zone to the point of interconnection with the electrical service (for single family residences the point of
interconnection will be the main service panel); a pathway for routing of plumbing from the solar zone to the water -heating
system.
§ 110.10(d):
A copy of the construction documents or a comparable document indicating the information from § 110.10(b) through § 110.10(c)
shall be provided to the occupant.
§ 110.10(e)l :
The main electrical service panel shall have a minimum busbar rating of 200 amps.
The main electrical service panel shall have a reserved space to allow for the installation of a double pole circuit breaker for a
§ 110.10(e)2:
future solar electric installation. The reserved space shall be: positioned at the opposite (load) end from the input feeder location or
main circuit location, and permanently marked as "For Future Solar Electric".
HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY
Project Name
Jack Jacobson
Date
7/15/2015
System Name
HVAC System
Floor Area
3,470
ENGINEERING CHECKS
SYSTEM LOAD
Number of Systems
2
COIL
CFM
Total Room Loads 1,649
Return Vented Lighting
Return Air Ducts
Return Fan
Ventilation o
Supply Fan
Supply Air Ducts
TOTAL SYSTEM LOAD
COOLING
PEAK COIL HTG.
PEAK
Heating System
Sensible
Latent CFM
Sensible
Output per System 45,000
33,263
3,905 589
22,820
Total Output Btuh 90,000
0
Output Btuh/s ft 25.9
1,920
1,122
Cooling System
0
0
Output per System 47,500
0
0 0
0
Total Output Btuh 95,000
0
3,905
0
Total Output Tons 7.9
1,920
1,122
Total Output (Btuh/s ft) 27.4
Total Output s ftfTon 438.3
1 37,104
25,063
Air System
CFM per System
0
HVAC EQUIPMENT SELECTION
Airflow cfm
0
York G616OC-110 - XC15-048 81,111
0
90,000
Airflow cfm/s ft
0.00
Airflow cfm/Ton
0.0
Outside Air %
0.0%
Total Adjusted System Output 1 81.111
(Adjusted for Peak Design conditions)
TIME OF SYSTEM PEAK
0
Aug 3 PM
90,000
Outside Air cfm/s ft 0.00
Note: values above given at ARI conditions
Jan 1 AM
HEATING SYSTEM PSYCHROMETRICS
Airstream Temperatures at Time of Heating Peak
26 OF
Outside Air
0 cfm
67 OF
67 OF '105 OF
Heating Coil
104 OF
ROOM
68 OF
COOLING SYSTEM PSYCHROMETICS Airstream Temperatures at Time of Cooling Peak
112/78°F
Outside Air
0 cfm
76 162 OF
76/63°F 55/54°F
Cooling Coil 56 ! 54 OF
48.7% � ROOM
75162 OF
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HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY
Project Name
Jack Jacobson
Date
7/15/2015
System Name
HVAC System
Floor Area
884
ENGINEERING CHECKS
SYSTEM LOAD
Number of Systems
1
COIL
CFM
Total Room Loads 458
Return Vented Lighting
Return Air Ducts
Return Fan
Ventilation 0
pp y Fan
Supply
Supply Air Ducts
TOTAL SYSTEM LOAD
COOLING PEAK
COIL HTG.
PEAK
Heating System
Sensible
Latent CFM
Sensible
Output per System 9,600
9,754
995 184
7,244
Total Output (Btuh) 9,600
0
Output Btuh/s ft 10.9
0
0
Cooling System
0
0
Output per System 9,700
0
0 0
0
Total Output (Btuh) 9,700
0
995
0
Total Output (Tons) 0.8
0
0
Total Output (Btuh/s ft) 11.0
Total Output s ft/Ton 1,093.6
9,754
7,244
Air System
CFM per System
1,800
HVAC EQUIPMENT SELECTION
Airflow cfm
1,800
Fujitsu General America AOU9R2
0
8,165
5,996
Airflow cfm/s ft 2.04
Airflow cfm/Ton
2,226.8
Outside Air %)
0.0%
Total Adjusted System Output
(Adjusted for Peak Design conditions)
1 TIME OF SYSTEM PEAK
0 8,165
Aug 3 PM
5,996
Jan 1 AM
Outside Air cfm/s ft 0.00
Note: values above given at ARI conditions
HEATING SYSTEM PSYCHROMETRICS
Airstream Temperatures at Time of Heating
Peak
26 OF
10
Outside Air
0 cfm
68 °F
68 OF 105 OF 105 OF
Heating Coil Supply Fan
1,800 cfm
FFT71 4
105 OF
ROOM
68 OF
COOLING SYSTEM PSYCHROMETICS Airstream Temperatures at Time of Cooling Peak
112/78°F
Outside Air
0 cfm
75162 OF
75/62°F 55/54°F ^ 55/54°F
Poof
1
Cooling Coil Supply Fan
1,800 cfm
46.8%
55 / 54 OF
� -_ROOiR
75 ! 62 OF
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